Backflow Compliance Survey Name on Account (required) Contact (Property Mgr) Email (required) Service Address (required) Pressurized Irrigation (if no, there is no futher action required) (required) YES NO UNSURE Existing Backflow Assembly/Device (if yes, book appointment with local tester) (required) YES NO UNSURE Appointment Needed (if UNSURE or NO on Existing Backflow) YES NO Date & Time Available for Appointment to Determine if there is an EXISTING Backflow Assembly (M-Th 7 am - 4 pm) 2nd Choice 3rd Choice No Existing Backflow Will Install in 2025 Will Install in 2026 Extension Needed beyond 2026 Picture Message There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
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