Quarter 01/01-03/31 04/01-06/30 07/01-09/30 10/01-12/31 Date of test / / To: Instructions: This form is to be completed for each test of each approved valve. It is to be mailed to the Supplier of Water and Local Administrative Authority within 5 days of each test and inspection performed by a Certified Tester. These forms shall be kept at the facility for a period of 5 years (N.J.A.C. 7:10-10.2(f)) and be exhibited upon request. From: (Name of Permit Holder) The backflow prevention d.
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How to fill out the NJ BWSE-CITR-IQ online
The NJ BWSE-CITR-IQ form is essential for reporting the quarterly tests of backflow prevention devices in New Jersey. This guide provides a comprehensive overview of how to accurately complete this form online, ensuring compliance with state regulations.
Follow the steps to accurately fill out the NJ BWSE-CITR-IQ form.
- Click ‘Get Form’ button to obtain the NJ BWSE-CITR-IQ form and open it in the document management system.
- Fill in the 'Date of Test' section by entering the date when the test was conducted, formatted as MM/DD/YYYY.
- In the 'From' section, provide the name of the permit holder responsible for the backflow prevention device. Ensure accuracy to avoid any discrepancies.
- In the 'Description of Valve' section, document the manufacturer, model number, size, and serial number of the valve being tested.
- Complete the testing results by filling in the appropriate checkboxes for the results of the 'Pressure Test' and 'Internal Inspection' as required.
- List any repairs made and materials used in the designated area, and note the results of the test after any repairs.
- In the 'Certified Testers Name' section, provide the name of the certified tester, their signature, and the certifying authority including their ID and expiration date.
- Complete the 'Witnesses to Test and Inspection' area by entering the titles of individuals present during the testing process.
- Review all information filled out to ensure accuracy and clarity before submission.
- Once all fields are completed, save changes to your document, and choose to download or print the form for final submission.
Complete your NJ BWSE-CITR-IQ form online today for timely compliance and reporting.
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Is backflow testing required in NJ?
Every water line on a property must have a backflow prevention device that is regularly maintained and annually tested.
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