Get Nyc Internal Backflow Test Report Form

Filling out the Nyc Internal Backflow Test Report Form online is a straightforward process that requires careful attention to detail. This guide will walk you through each section of the form, ensuring you provide all necessary information accurately.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in the digital editor.
2. In the 'Test Report Information Part 1' section, complete all fields thoroughly. This includes entering the public water supply details, county, block, state, zip code, lot number, permit number or LAA number, facility name, facility address, city, device manufacturer, device model, size of the device, month of the report, serial number of the device, specific location of the device, and the end use of the device (such as boiler, cooling tower, or medical).
3. Next, move to 'Test Report Information Part 2', which must be completed by a certified backflow prevention device tester. Here, fill in details for Check Valve No.1, including the pressure drop across the first check valve. Then, provide information for Check Valve No.2 regarding any leaks or tightness and the differential pressure relief valve, if applicable.
4. Document the name of the repairer and describe any repairs made, including parts and materials used. Also, include the name, license number, and seal of the master plumber, along with the date of repair.
5. Complete the final test section, providing the pressure drop across the first check valve and whether it closed tightly. Indicate the date of this test, the completion time, and whether the device is new or a replacement.
6. Finally, in the 'Statements and Signature' section, indicate whether you are the licensed master plumber of record, print the plumber's name, and provide the seal and license number. Ensure you include your signature and the date.
7. After completing all sections, save your changes. You can then download, print, or share the form as necessary.

Complete your documents online today to ensure timely submission.