Commercial Backflow Prevention Survey Form
Sample: Backflow form mailed to commercial utility customers.
A cross-connection reporting form is mailed to all commercial utility customers and can be returned by mail in the envelope provided or it can be filled out and submitted below to fulfill the reporting requirement. All fields are required. If you wish to continue to receive water service within the City you must return the completed form to the Office if the Building Inspector, as it is a State requirement.
Please make sure you have included your address in the appropriate spaces.
If you have any questions please contact Brad Bailey, City of Crete Building Inspector, at 402.826.4312.
COMMERCIAL BACKFLOW PREVENTION 2021 SURVEY FORM
Please inspect your plumbing system and select an answer to the following questions.