Backflow Prevention Assembly Test Report

West Sound Utility District will accept only our approved test report form. The tester will fill out the form completely and e-mail or fax the completed form to WSUD. Below you will find links to both a simple print out for filling out by hand and a fillable form version.

It is recommended that the fillable form version be completed in Adobe Acrobat DC. The ability to add a signature is not supported when opening it from a web browser.

Once the form is filled out it can be faxed or emailed back to the district. Please include a copy of the testers certification card and the test kit calibration report.
E-mail: crossconnection@wsud.us
Fax: 360-876-2587

Incomplete forms will not be accepted.

PLEASE BE SURE TO EMAIL YOUR COMPLETED FORM TO:

crossconnection@wsud.us