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2018 Backflow Device Inspection Report Submission Form

  1. Thank you for taking the 2018 commercial cross connection survey. This survey aids the Village in minimizing the risk of backflow contamination in the public water system. Please review the options below and submit your responses by no later than Friday, August 31.

  2. Water Customer Information

  3. Please upload your most recent test certification(s) here. If you have questions regarding what information is needed, please contact us at 847-664-4129 before submitting this form.

  4. Please note that in completing this field, you certify that, to the best of your knowledge, all of the preceding information is accurate and true.

  5. Leave This Blank:

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