and Backflow Prevention
templates below are the samples contained in the Cross-Connection and Backflow Prevention Manual - WVBPH, but are
in Microsoft Word for easier use of copying and pasting the information your water system needs to maintain its Cross-Connection Control Program.
Sample Ordinance for Municipalities
Sample Policy for Public Service Districts
Sample Letter of Intent to Inspect
Sample letter for Device Installation
Sample Survey Form
Sample Test Report
maintained by the Training and Certification Program.
Please address any comments or questions
to the program or the