Backflow Test Form

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Village of Mount Prospect Backflow Assembly Test and Certification Report

To download a copy of the Village of Mount Prospect Backflow Assembly Test and Certification form, please follow this link.

Effective January 1, 2006, this form will be the only form accepted for the documentation of annual backflow preventer testing requirements. Backflow preventer testers submitting test results on proprietary or third-party forms will be required to resubmit results on the Village of Mount Prospect form. Test results WILL NOT be accepted unless received on the proper form.