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Washington State Incident Report Form

The link below will take you to the current version of the Washington State Incident Report Form. Simon Tung (DOH) has written an article about the incident report form, it will be published in the next Northwest CCC Journal (SRC4) newsletter which will be coming out later this summer. If you have any comments about the Incident Report Form WAStateBackfloRept-F.doc please contact Simon at 360-236-3123 or simon.tung@doh.wa.gov.

Washington State Approved Assemblies List

For an Approved Assemblies list from the DOH go to www.doh.wa.gov/ehp/dw than go to the publications page and request DOH Publication # 331-137.

Backflow Assembly Test Report Form

"The Group" has developed  a Backflow Assembly Test Report form to be used by BAT's and water purveyors. It is accepted by most water purveyors in Washington State and is recognized by the Department of Health as the State backflow assembly test report form. The form is in Word format so you can add your personalized touch (company name, phone number, water district, etc....).

Installation Brochures

The two links below are brochures for the installation of  DCVA's and RPBA's. These were created through "The Group" as well.  Please feel free to use as needed. Be sure to contact your water purveyor before installation.

Double Check Valve.pdf

Reduced Pressure Backflow.pdf

CCS Public Listing Information

Here you will find information about the CCS Public Listing and an application form to get on the Washington State list.

Numbers to Know

The contact at WETRC is David Kingsley for professional growth (BAT) and backflow certification (253) 833-9111 ,Ext 3371.

WDM, WDS, CCS, and WTP Certifications are sent out by Washington State Department of Health

Terri Notestine 360-236-3133 terri.notestine@doh.wa.gov (CCC related calls)

Simon Tung 360-236-3132 simon.tung@doh.wa.gov (CCC related calls)

For Operator Certification business only: 1-800-525-2536
For all other Drinking Water business: 1-800-521-0323