2. 

4. Tester Information Form

6. Please fill out form to apply or update tester information. Contact backflow@cvwdwater.com if you have any questions or issues.

   Allow 24-48 hours for information to be  updated in our system.

   PLEASE NOTE: SB County certifications will only be valid until 6/30/2025! Please upload your ANSI accredited (such as AWWA) certification to continue testing devices in our service area.

8. Tester Information
10. Tester's Name*
11. Tester's Email*
13. ANSI Accredited Certification or SB County Certification #*
14. Expiration*
15. Upload Certification*
17. Company Information
19. Company Name*
21. Business Address*
23. City*
24. State*
25. Zip*
27. Mailing Address
29. City
30. State
31. Zip
33. Company Email*
34. Phone Number*
36. City of Rancho Cucamonga Business License No.*
37. Expiration*
39. Upload License*
41. Primary Gauge
43. Test Kit Make*
44. Model*
46. Serial Number*
47. Calibration Date*
49. Upload Calibration Certificate (Calibration must be within the last 12 months)*
51. If Multiple Gauges, Upload Calibration Here
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field