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Backflow Technician Information Submittal

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This page is to allow Backflow Technicians to submit their information to be included in the Geographical Tester Listing. Numerous organizations are contacted frequently by consumers, to provide lists of backflow technicians and testers in their area. Being listed on the BPECC website is a benefit to contract backflow tester, and provides a needed source of information for consumers.

All data indicated in the form below must be filled out completely. Only a small portion of the information submitted will be included in the geographical listing for consumers, but the rest may be required to contact you for updated information. Use the comments field at the end of the form to submit any privacy concerns.

Due to this being a volunteer effort, submitted data is processed once a month, but sometimes more often depending on workload. If there are questions on the data you have provided, we may contact you for clarification before adding you to the listings. Be sure the certifications you list include the correct certification number and expiration date, as we are checking with the approval agencies for verification of the information you have submitted.

Individual & Company Information	Once you type in the first field, use your TAB key to advance to the next field.
*First Name*
*Last Name*
*Company Name*
*Company Street Address*
*Company Street Address 2*
*City*
*State (format: CO)*
*Zip (format: 99999)*
*Email Address (format: yourname@yourdomain.com)*
*Phone # (format: 555-555-5555)*
*Fax # (format: 555-555-5555)*

Regions you work in:
Please review the map on previous page for the 5 regions of Colorado (The boundaries are guidelines, not absolutes. If you are on a border and you are unsure, it is better to check both). Check all the buttons for the areas you wish to perform contract backflow testing and repair (You must check at least one, or we will disregard this form submission).
*Check this one if you work the Metro Area*	#1 Metro Area
*Check this one if you work the Northeast Quadrant*	#2 Northeast
*Check this one if you work the Southeast Quadrant*	#3 Southeast
*Check this one if you work the Southwest Quadrant*	#4 Southwest
*Check this one if you work the Northwest Quadrant*	#5 Northwest

Tester Certifications (Check those that you currently possess and are valid)
	Colorado Cross-Connection Certification (If checked, submit the following, cert # and expiration date)
*Colorado Certification Number*
*Colorado Certification Expiration Date*
	ABPA Certification (If checked, submit the following, cert # and expiration date)
*ABPA Certification Number*
*ABPA Certification Expiration Date*
	ASSE Certification (If checked, submit the following, cert # and expiration date)
*ASSE Certification Number*
*ASSE Certification Expiration Date*

Comments

You must click the Submit button below to send your information, use the Reset button to clear the form and start over.

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Colorado Primary Drinking Water Regulations

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