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Cross-Connection Control Commercial

  1. Are you the property owner?

  2. Alternate Water Source*

  3. If yes, please indicate which source you have

  4. Baptismal Fountain/Tub*

  5. Boiler or Steam Heat*

  6. If yes, please indicate boiler type

  7. Car Wash Facilities*

  8. Chemical Feeder*

  9. Chlorinator*

  10. Commercial Dishwasher*

  11. Dental Equipment*

  12. Fire Sprinkler Protection System*

  13. Industrial Fluid System*

  14. Lawn Irrigation System*

  15. Private Yard Hydrant*

  16. Photo Processor*

  17. Pressure Booster*

  18. Shampoo Bowl/Sink*

  19. Soap Injector*

  20. Soft Drink Dispenser*

  21. Steam Equipment*

  22. Sterilizer*

  23. Swimming Pool/Hot Tub*

  24. Truck or Tank Filling*

  25. Water Cooled Equipment*

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

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

    Backflow Preventer

  28. 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.

  29. Leave This Blank:

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