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Get NJ BWSE-CITR-IQ 2013-2024

Quarter 01/01-03/31 04/01-06/30 07/01-09/30 10/01-12/31 Date of test / / To: Instructions: This form is to be completed for each test of each approved valve. It is to be mailed to the Supplier of Water and Local Administrative Authority within 5 days of each test and inspection performed by a Certified Tester. These forms shall be kept at the facility for a period of 5 years (N.J.A.C. 7:10-10.2(f)) and be exhibited upon request. From: (Name of Permit Holder) The backflow prevention d.

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