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CROSS CONNECTION PLAN REVIEW APPLICATION Environmental Health Division 5050 Commerce Drive, Rm 116, Baldwin Park, CA 917061423 www.publichealth.lacounty.gov/eh (626) 4305290 Fax# (626) 8133025DateProject
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How to fill out cross connection plan review

01
Begin by reviewing the requirements and guidelines set forth by your local regulatory agency for cross connection plan reviews.
02
Gather all necessary information and documents, including a site plan, plumbing diagrams, and fixture counts.
03
Identify potential cross connection hazards, such as dual plumbing systems or shared water sources.
04
Develop a detailed plan to prevent backflow and contamination, including the use of appropriate backflow prevention devices.
05
Complete the cross connection plan review form, ensuring all required information is provided.
06
Submit the plan review form along with any supporting documents to the relevant regulatory agency.
07
Await feedback and follow up with any requested revisions or additional information.
08
Once the cross connection plan is approved, implement the necessary backflow prevention measures and regularly inspect and maintain them.
09
Keep a record of the approved cross connection plan and associated documentation for future reference and compliance purposes.

Who needs cross connection plan review?

01
Cross connection plan review is typically required for any entity or individual responsible for a water system or plumbing installation that poses a potential risk of backflow or contamination.
02
This includes property owners, businesses, government agencies, and utility providers.
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Cross connection plan review is a process to evaluate and approve plans that identify and prevent potential contamination of drinking water from non-potable sources.
Any facility or property owner that has potential cross connections between potable and non-potable water sources is required to file a cross connection plan review.
To fill out a cross connection plan review, the facility owner must provide detailed information about the plumbing system, potential cross connections, and the proposed measures to prevent contamination.
The purpose of cross connection plan review is to ensure the safety of drinking water by identifying and preventing potential sources of contamination.
The cross connection plan review must include information about the facility's plumbing system, potential cross connections, and details of the proposed prevention measures.
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