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Este formulario es utilizado para certificar la exención del programa de pruebas de dispositivos de retroceso para aquellos que cumplen con ciertos criterios relacionados con sistemas de riego, bombas de suma, piscinas, calderas y pozos de agua. Los solicitantes deben verificar ciertas condiciones marcando las casillas correspondientes.

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How to fill out cross connection exemption certification

01

Step 1: Obtain the cross connection exemption certification form from your local water authority or utility provider.

02

Step 2: Read the instructions carefully to understand the requirements.

03

Step 3: Fill in your personal information including your name, address, and contact details.

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Step 4: Provide information about the property where the cross connection exists.

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Step 5: Describe the nature of the cross connection and how it may affect the water supply.

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Step 6: Attach any supporting documents that may be required, such as diagrams or photographs.

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Step 7: Review your application for completeness and accuracy.

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Step 8: Submit the completed form to the relevant authority, either by mail or online.

Who needs cross connection exemption certification?

01

Property owners or managers who have identified a potential cross connection in their water supply.

02

Businesses that utilize water supply systems with potential hazards, such as irrigation systems, industrial processes, or plumbing modifications.

03

Anyone who requires an exemption for a specific cross connection as per local regulations.

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What is cross connection exemption certification?

Cross connection exemption certification is a formal document that allows certain entities to exempt themselves from specific regulations regarding cross connections, which are actual or potential connections between a potable water supply and a non-potable source.

Who is required to file cross connection exemption certification?

Entities such as public water systems, businesses, or facilities that have potential cross connections and need to operate under specific exemptions must file cross connection exemption certifications.

How to fill out cross connection exemption certification?

Filling out a cross connection exemption certification typically involves providing detailed information about the facility, describing the nature of the exemption, and ensuring compliance with any local or state regulations. It's important to follow the specific instructions provided by the regulatory authority.

What is the purpose of cross connection exemption certification?

The purpose of cross connection exemption certification is to ensure that public health is protected by allowing certain exemptions while still monitoring and controlling the potential risks associated with cross connections.

What information must be reported on cross connection exemption certification?

Information that must be reported on cross connection exemption certification typically includes the entity's contact information, details about the specific cross connection, justification for the exemption, and any corrective measures that will be taken to ensure safety.

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