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.

Email original test report to backflowtest@ci.fullerton.ca.us or mail the original completed test report form to:

City of Fullerton
Engineering Department
Attention: Water Quality Specialist
303 W. Commonwealth Ave
Fullerton, CA 82832

Email: a copy of the test report ocbackflowtest@ochca.com or mail the copy to:

County of Orange Health Care Agency
Water Quality Section
1241 E. Dyer Rd., Suite 120
Santa Ana, CA 92705-5611

Free viewers are required for some of the attached documents.
They can be downloaded by clicking on the icons below.

Acrobat Reader Windows Media Player Word Viewer Excel Viewer PowerPoint Viewer