Backflow Tester Registration

City of La Habra

Backflow Assembly Tester Sign-Up

Please complete the below form to submit your most current contact and tester certification information to the La Habra, CA.

Tester Information

We use this information to make sure we have the most current contact and certification information in our database.

Name *

First

Last

Email *

*Must be a UNIQUE, individual email address.

Phone *

Testing Company Information

We use this information to create your Service Provider profile in SwiftComply.

Company name *

*If you are self-employed, write "Self."

Company Phone Number *

Company Address *

Company Address Line 2

City *

State *

Zip Code *

Tester Credentials

A current, valid backflow assembly testing certification and test kit calibration is required in order to submit test reports through SwiftComply.

Certification *

Certification Expiration *

Year

Certification Expiration Month *

Month

Certification Expiration Day *

Day

Agency *

Certification Documentation Upload *

Click or drag a file to this area to upload.

Please attach a current copy of your backflow testing certification document.

Test Kit *

Date of Last Calibration *

Year

Calibration Month *

Month

Calibration Day *

Day

Manufacturer *

Model *

Test Kit Calibration Documentation Upload *

Click or drag a file to this area to upload.

Please attach a copy of your most recent test kit calibration documentation.

Additional Testers

You can add up to 3 testers on one form. Please reload this form if you need to add additional testers.

Would you like to add another tester under the same testing company? *

City of La Habra

Backflow Assembly Tester Sign-Up

Tester Information

Testing Company Information

Tester Credentials

Additional Testers

Tester Information (Tester #2)

Tester Credentials (Tester #2)

Additional Users

Tester Information (Tester #3)

Tester Credentials (Tester #3)

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