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Cross-Connection Control Commercial

  1. Are you the property owner?

  2. Please indicate which of the following you have:

  3. Alternate Water Source*

  4. If yes, please indicate which source you have

  5. Baptismal Fountain/Tub*

  6. Boiler or Steam Heat*

  7. If yes, please indicate boiler type

  8. Car Wash Facilities*

  9. Chemical Feeder*

  10. Chlorinator*

  11. Commercial Dishwasher*

  12. Dental Equipment*

  13. Fire Sprinkler Protection System*

  14. Industrial Fluid System*

  15. Lawn Irrigation System*

  16. Private Yard Hydrant*

  17. Photo Processor*

  18. Pressure Booster*

  19. Shampoo Bowl/Sink*

  20. Soap Injector*

  21. Soft Drink Dispenser*

  22. Steam Equipment*

  23. Sterilizer*

  24. Swimming Pool/Hot Tub*

  25. Truck or Tank Filling*

  26. Water Cooled Equipment*

  27. Other Equipment with a Direct Connection to City Water*

  28. Do you have backflow preventers on your property?*

    Backflow Preventer

  29. Pictures of devices in question can be e-mailed for review by the City’s Plumbing Inspector. The City’s Plumbing Inspector can also be contacted via phone at 309.524.2374.

  30. Leave This Blank:

  31. This field is not part of the form submission.