Mount Gilead, OH · Morrow County
Approved Backflow Tester Application
Certified backflow assembly testers submit this application and supporting credentials to be considered for Mount Gilead’s approved tester list.
What this form is
Certified backflow assembly testers use this application to request placement on the Village of Mt. Gilead’s approved tester list. Applicants must provide a current state tester certificate and equipment calibration certificates; additional state fire marshal certification is required for testing fire suppression system assemblies. The application asks for business contact details, test equipment information, certification numbers, and the tester’s signature and date.
Who needs it
Certified backflow assembly testers seeking placement on the Village of Mt. Gilead’s approved list must submit this application with the required credentials.
How to submit it
Return the completed application and required documentation by email, fax, mail, or in person to the Backflow Prevention contact at 72 W. High Street, Mt. Gilead, Ohio 43338. The form lists fax 419-946-8111 and [email protected].
About notarization
This application is signed and dated without a notary; the required certification cards and equipment calibration certificates are copies, with no sworn attachment identified.
How to submit this form
- 1
Download The Application
Download the Mount Gilead application for the approved backflow assembly tester list.
- 2
Complete The Application
Print clearly and provide your business contact details, equipment information, certification number, and tester signature and date.
- 3
Gather Required Documents
Include copies of your current state certification card and equipment calibration certificate; fire suppression testing requires an additional state certificate.
- 4
Submit To The Village
Email, fax, mail, or deliver the completed application and required documents to the Backflow Prevention contact using the form’s details.
Frequently asked questions
- Who should submit the Mount Gilead backflow tester application?
- Certified backflow assembly testers seeking placement on the Village of Mt. Gilead’s approved tester list should submit the application and required documentation.
- What documents must accompany the application?
- Include a copy of the current state backflow tester certification card and current equipment calibration certificate. Fire suppression system testing also requires a current State Fire Marshal certificate.
- Do I need a notary for the Mount Gilead backflow tester application?
- No. The application requires the tester’s signature and date, but no notary; the listed certification cards and calibration certificates are copies, not sworn attachments.
- How do I submit the backflow tester application?
- Send it by email, fax, or mail, or deliver it in person to the Backflow Prevention contact at 72 W. High Street, Mt. Gilead, Ohio 43338. Contact details are printed on the form.