Backflow Prevention I Cross-Connection
Control Program
Backflow Prevention Assembly Tester
Registration Packet
BACKFLOW PREVENTION PROGRAM
BACKFLOW ASSEMBLY TESTER REGISTRATION REQUIREMENTS:
(ALL OF THESE CAN BE COPIES)
DEVELOPMENT
SERVICES
•
•
•
•
Certificate of completion from school attended OR
40 hour or 8 hour re-certification (not over 3 years old)
TCEQ Backflow Assembly Tester license
A local gauge test not over 1 year old
(Manufacturer's gauge test not accepted)
2406 Leopard
•
Current Texas D r iver's L icense
(picture has to be recognizable)
First Floor
Corpus Christi
Texas78408
Phone (361)826-3240
If you are registering to test FI RE LI N E backflow prevention
assemblies, you will also need:
•
A notarized statement on company letterhead from your employer with
the SCR number stating that you are a full time employee of that
company.
CITY OF CORPUS CHRISTI REGISTERED BACKFLOW
PREVENTION ASSEMBLY TESTERS REGULATIONS AND
REQUIREMENTS
In the past several years many of the requirements for testers have gradually changed.
Below is a list of requirements all testers must follow:
DEVELOPMENT
SERVICES
2406 Leopard
First Floor
Corpus Christi
Texas78408
Phone (361)826-3240
o All testers must supply both business and personal addresses and telephone
numbers, current gauge certifications, a valid tester license, a valid Texas driver's
license and be registered with the City of Corpus Christi in order to test backflow
prevention assemblies within our city limits.
o As per TCEQ regulation 290.44 (b) (4) (A) (i), backflow prevention assembly
testers are qualified to test and repair assemblies on any domestic, commercial,
industrial or lawn irrigation service.
o As per TCEQ regulation 290.44 (b) (4) (A) (ii), backflow prevention assembly
testers may test and repair assemblies on fire lines only if they are permanently
employed by an APPROVED FIRE LINE CONTRACTOR.
o The T&M report is a legal document which required the tester's original
signature. The signature may not be stamped or copied.
o T&M reports must be in our office no more than (10) calendar days from the
date tested. Test reports submitted late will be rejected and the tester will be required
to retest the device.
o Assemblies that FAIL must have a T&M report submitted in the same manner
as a passing test report. Do not hold the test until the assembly is repaired unless
the repair is made the same day.
o Assemblies that are REMOVED must have a T&M report submitted in the same
manner as any other test report. NO FILING FEE IS CHARGED FOR A REMOVAL.
o A filing fee must be submitted with the T&M report(s) for each SEPARATE
address. The filing fee is charged per device.
REQUIREMENTS FOR FILLING OUT TEST AND MAINTENANCE
REPORTS
DEVELOPMENT
SERVICES
•
Send in original ONLY (on local form)
•
Fill in ALL information
•
List any repair kits/parts by brand name and part number
•
List the repair that was made, if any
•
Submit a T&M report for any valve which has been
discontinued/removed along with the reason for the discontinuation or
removal.
•
When replacing a backflow prevention assembly, make a note
on the T&M report as to which device it is replacing
•
T&M reports must be received by our office within ten (10)
calendar days of the test date ·
2406 Leopard
First Floor
Corpus Christi
Texas 78408
Phone {361) 826-3240
PERMITS ARE REQUIRED FOR ALL NEW OR REPLACEMENT BACKFLOW
PREVENTION ASSEMBLIES:
New Backflow Prevention Assemblies must be installed the proper height
and in such a manner that the serial number can be easily read in order to
pass inspection.
BACKFLOW PREVENTION DEVICE TEST FILING FEE
Development Services
2406 Leopard Street
Corpus Christi, Texas 78408
(361) 826-3240 (361)826-4346 (fax)
FORM MUST BE FILLED OUT COMPLETELY
Date
_
Property Address
_______________________________________________________
Property Owner
_______________________________________________________
Backflow filing fee(s) X $20.00 = $
(, amt. to be paid to cashier)
Tester’s BPAT License #
Tester’s Name
E-mail address
Tester’s mailing address
City
State
Zip
Name of company you are employed by or name registered with State Comptroller’s Office:
Company Name
_
Business Mailing Address
City __
Phone (
__State
) _____________________________ Fax (
Zip
_
)
I hereby affirm under the penalty of perjury that all of the acts, statements, and answers herein are true.
____________________________________
Signature of Backflow Assemb ly Tester
______________________________
Print Name
OFFICE USE ONLY:
Application Number:
______________________________
Backflow Prevention Assembly Testers who wish to have their business name and
telephone number listed on the City of Corpus Christi Website need to complete this
form and submit it to the Backflow Prevention Program Office.
The tester certification is yours alone and you are responsible for the test and
maintenance reports.
DEVELOPMENT
SERVICES
Last name
Business Phone
2406 Leopard
First Floor
Corpus Christi
Ttxas78408
Phone (361) 826-3240
First
Ml
_
_
Cell
e-mail
_
Business Address
_
City
State
Zip
Business Name ________________________________________________________
Mailing address ________________________________________________________
City
Fax Number
Gauge Manufacturer
State
Zip____________
BPAT License No. ____________
Model No.___________________
Gauge Serial Number ________________________________________________
Signature ____________________________________________________
Date __________________
City of Corpus Christi
2406 Leopard Street
Corpus Christi, Texas 78408
(361) 826-3240 (361) 826-4346 (fax)
Permitrequests@cctexas.com
BACKFLOW PREVENTION ASSEMBLY TESTER REGISTRATION 2015
New Registration
Registration Re-newel
Name
Date
(Please print full name)
Mailing Address
_
City
State
Telephone (
)
Zip
_
_____________
Driver's License # ___________________________________Date of Birth
Registration Fee ($135.00)
Copy of TCEQ Tester License, Gauge Test, Driver's License
State Backflow Assembly Tester License # _____________________________________
Name of Company you are employed by or name registered with State Comptroller's office:
Company Name
_
Business Location______________________________________________________
E-Mail _______________________________________________________
Mailing Address ----------------------------City
Phone (
State
) __________________________
Type of ownership (check one):
Corporation
Sole Proprietor
Other (explain)
Zip
Fax (
___
) __________________
_____ Joint Venture
_____ Partnership
_
I hereby affirm under penalty of perjury that all of the acts, statements and answers are herein true.
Signature of Licensed Person -----------------------
Processed by
Date __________ Bus Control #
App #15_________