Preprinted backflow test report forms, containing the make, model, size, serial number and site location, can be obtained for any existing backflow by contacting the Water Quality Specialist. Otherwise, the tester may submit results for any backflow assembly test by using the City of Fullerton’s standard blank test report form available online.
Backflow Test Form (pdf)
Records of such tests, repairs and overhauls must be provided to the City of Fullerton and the County of Orange Health Care Agency for their respective permanent files.
Mail the original completed test report form to:
City of Fullerton
Attention: Water Quality Specialist
303 W. Commonwealth Ave
Fullerton, CA 82832
Mail a copy of the completed test report form to:
County of Orange Health Care Agency
Water Quality Section
1241 E. Dyer Rd., Suite 120
Santa Ana, CA 92705-5611