Get Cross Connection Control Assembly Removal Notice

The Cross Connection Control Assembly Removal Notice is an essential document used to report the removal of a backflow assembly from a water system. This guide provides step-by-step instructions to help you fill out this notice online effectively.

Follow the steps to complete the notice accurately.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Input the current date in the designated DATE field.
3. Fill in the PROJECT NAME field with the name associated with the project.
4. In the ADDRESS field, enter the complete address where the assembly was located.
5. Complete the REGULATED OBJECT # field with the specific identification number of the assembly.
6. Provide the CITY/ZIP codes for the address entered above.
7. Enter the MANUFACTURER of the backflow assembly in the corresponding section.
8. Specify the SIZE and SERIAL NO. of the assembly in the appropriate fields.
9. Describe the RP LOCATION in detail, indicating where the reduced pressure assembly was situated.
10. Address the questions in the form, ensuring to indicate whether the reduced backflow assembly is still on the water line using the YES/NO options provided.
11. If it has been removed, state where it is currently located, such as IN STORAGE.
12. Indicate whether the water line has been capped, using the provided YES/NO options.
13. If applicable, mention if the assembly was DESTROYED.
14. Complete the additional section on downstream protection if the assembly has been removed.
15. Sign the form by printing your name, as well as providing your signature and title in the respective areas.
16. Once completed, save your changes, download, print, or share the form as necessary.

Complete your Cross Connection Control Assembly Removal Notice online today.