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Backflow Tester Application

Backflow Assembly Tester Application

All new testers must submit this application to be added to the approved Marin Water Testers List. After review of your documents, we will process your application and schedule a hands-on demonstration held bi-annually in April and October.

Contact us at 415.945.1488 or with any questions.

Published List
Technician Address
Company Address
Company Address

Test Kit #1 Information

Test Kit #2 Information


Contractor License Number

Insurance Information

Backflow Assembly Tester Expectations

As a Backflow Assembly Tester performing backflow preventer testing within the Marin Water service area, I agree to the following:

  • I will maintain a current Backflow Assembly Tester certification issued by CA/NV AWWA or ABPA and submit this certification to Marin Water.
  • To submit to Marin Water, prior to expiration, verifiable current copies of my Temporary Tester Certification (if issued), Tester Certification including Wall Certificate, Wallet Card and Gauge Accuracy Report.
  • If my tester certification has expired, I will inform Marin Water that I have recertified. If I fail to do so, I understand that I will be removed from the approved testers list.
  • To inform the district of any changes in my tester status, address, phone number or employment.
  • Removal, replacement, or relocation of a backflow assembly is not permitted without first obtaining the approval of the District Backflow Group.
  • All backflow preventer field test reports shall be submitted via the Marin Water Web Assist web site within 7 days of the initial test. If there is a specific problem relating to the test or the test report, I will email the Marin Water Backflow Group advising of the problem as soon as possible at
  • I will attend a Marin Water backflow prevention assembly tester update seminar when offered, at least once every two years.

Submitting falsified results of any backflow assembly field tests performed shall result in removal from the list of approved testers list. Examples of falsified results include:

  • Submitting test reports that she/he did not personally perform.
  • Not documenting correct test data, i.e. date, time, test results.
  • Not having proper tester certification.
  • Not using current approved test procedures established by USC FCCC&HR.
  • Not using test equipment with current gauge certification on file with Marin Water.

I understand that if I fail to comply with these expectations, I may be subject to the loss of testing privileges within the Marin Water service area. If I am removed from the list of testers, it will be for no less than six months. If the removal is for something other than certification expiration, I understand that the certifying organization will be notified. A second removal from the tester list may lead to permanent removal of the tester from the Marin Water list of testers.

I understand that if removed from the list of approved testers for any reason, I will successfully perform a hands-on demonstration of backflow prevention assembly testing in the presence of district staff in order to be returned to the approved testers list. The method of testing shall be the current method adopted by the certifying organization. Marin Water will schedule the hands-on demonstration twice annually.

I have read, understand and agree to abide by the expectations listed above while testing backflow prevention assemblies in the Marin Water service area. I also understand that falsification of any information submitted on the any field test report shall be cause for the termination of backflow testing privileges.


After submitting your application, please scan and email copies of your original AWWA/ABPA tester wall certificate, current AWWA/ABPA wallet card, and current test kit calibration report to

Applications will not be processed until electronic copies of these materials have been received. Only scanned email copies will be accepted. No faxed, mailed, or hand-delivered copies will be accepted.