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CrossConnection Control Program Environmental ControlCrossConnection SurveyReceipt Number: (for office use only) ___Surveyor Information (please print) Survey Date: Surveyor Company:Facility Name:Surveyor
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How to fill out submit a cross connection

01
To fill out and submit a cross connection, follow these steps:
02
Start by gathering all the necessary information, including the type of cross connection, the location, and any relevant documentation or permits.
03
Begin the application process by contacting the appropriate regulatory agency or water department in your area.
04
Obtain the necessary application forms or permits and carefully read all the instructions.
05
Fill out the application form accurately and completely, providing all the required information, such as your name, contact details, and property information.
06
Attach any supporting documents or permits as required, making sure they are in the correct format and follow any specific guidelines.
07
Review the completed application to ensure all information is correct and there are no errors or omissions.
08
Submit the application and any accompanying documents to the designated agency or water department.
09
Pay any applicable fees or charges associated with the cross connection application.
10
Await review and processing of the application. This may involve inspections or additional requirements depending on the nature of the cross connection.
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Once the application is approved, you will receive confirmation and any necessary instructions for proceeding with the cross connection.
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Note: The specific process and requirements may vary depending on your location and the regulatory agency involved. It is important to follow all instructions and comply with any local regulations.

Who needs submit a cross connection?

01
Various individuals or entities may need to submit a cross connection, including:
02
- Property owners or managers who want to establish a new cross connection or modify an existing one.
03
- Contractors or plumbers responsible for installing or maintaining cross connection devices.
04
- Municipalities or water departments enforcing regulations and overseeing cross connection control programs.
05
- Industries or commercial establishments that require specific cross connections for their operations.
06
- Individuals or businesses in regions with particular water quality or health concerns that require cross connection mitigation measures.
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- Any person or organization that wants to ensure the safety and integrity of their drinking water supply by preventing contamination through cross connections.
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It is important to consult the relevant local regulations or authorities to determine if you need to submit a cross connection and to understand the specific requirements and processes involved.
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Submitting a cross connection refers to the process of reporting the existence of any cross connections between a potable water supply and a non-potable source, which may pose a risk of contamination to the drinking water system.
Any property owner or manager who has installed potential cross connections or any commercial or industrial facilities that might affect the safety of the public water supply are typically required to file a submission for a cross connection.
To fill out a submission for a cross connection, you typically need to complete a specific form provided by your local water authority, detailing the location of the cross connection, its purpose, and any required safety measures in place.
The purpose of submitting a cross connection is to ensure the safety of the drinking water supply by identifying potential risks and implementing preventive measures to avoid contamination.
Information that must be reported includes the location of the cross connection, the type of cross connection, the names of the facilities involved, and any risk mitigation measures taken.
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