Get Annual Backflow Device Maintenance Form - Medina County ...

Filling out the Annual Backflow Device Maintenance Form for Medina County is essential for ensuring compliance with safety regulations. This guide provides clear instructions on how to complete the form online, making the process straightforward and efficient.

Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Indicate the type of property by selecting either 'Commercial' or 'Residential' as applicable.
3. Enter the backflow test date in the designated field.
4. Fill in the name of the premise and the service address, including the city and ZIP code.
5. Provide the contact person's name and the location of the backflow assembly.
6. Select the type of backflow assembly by marking one or more of the provided options such as Domestic, DCVA, Fire Line, etc.
7. Choose the status of the installation, indicating if it is 'New Installation,' 'Existing,' or 'Replacement.'
8. Complete the section regarding the initial test results by indicating whether it 'Passed' or 'Failed.'
9. Fill in the serial numbers for the old assembly and the model information as required.
10. Complete the check valve details for each valve included in the assembly, noting their conditions.
11. Document the air gap inspection, confirming if the required minimum air gap separation is provided.
12. Fill in remarks as necessary for additional comments or instructions.
13. Sign the form as the tester, including your certification number and printed name.
14. Enter the company name, expiration date, and contact details for follow-up.
15. Once all fields are completed, save the changes, download, print, or share the form as needed.

Complete your Annual Backflow Device Maintenance Form online today for hassle-free compliance.