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CROSS CONNECTION SURVEY REPORT FOR PREMISE ISOLATIONMunicipal Works Division 1225 Ontario Street Cornwall, ON K6H 5T9 Tel: (613) 9302787 ext 2253 Fax: (613) 9338567 Email: backflow@cornwall.caWATER

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How to fill out cross connection survey report

01

Obtain a copy of the cross connection survey report form.

02

Identify all potential cross connection points in the building or facility.

03

For each cross connection point, check if there is a backflow prevention device installed.

04

Fill out the form with detailed information about each cross connection point and the corresponding backflow prevention device.

05

Include any additional comments or observations about the cross connection points.

06

Submit the completed cross connection survey report to the appropriate authorities.

Who needs cross connection survey report?

01

Property owners or managers of buildings or facilities that have potential cross connection points.

02

Government agencies or regulatory bodies responsible for overseeing water supply and quality.

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What is cross connection survey report?

Cross connection survey report is a report that identifies potential cross connections between potable water sources and non-potable water sources.

Who is required to file cross connection survey report?

Companies and organizations that own or operate facilities with potential cross connections are required to file a cross connection survey report.

How to fill out cross connection survey report?

Cross connection survey report can be filled out by conducting a thorough inspection of the facility to identify potential cross connections and submitting the findings in the required report format.

What is the purpose of cross connection survey report?

The purpose of cross connection survey report is to ensure that potable water sources are protected from contamination by non-potable water sources.

What information must be reported on cross connection survey report?

The report must include a list of potential cross connections identified, their locations, and proposed measures to eliminate or control the cross connections.

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