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Water Company: MDC CT Water
Other:

Backflow device location: Front Left Side
Back Right Side Don't Know

Is device accessible from outside? Yes No

Are there any other factors to prevent access (dog, fence, neighbors)? Yes No
If yes, please indicate:

Has the device ever been tested? Yes No
(If no additional charges apply.)

By checking the box below and submitting my request, I agree to have Advanced Backflow Services, Inc. test my backflow device.  I have read and agree to the testing rates and additional charges that may apply.  I  understand that ABS, Inc will forward my official test results to the Connecticut Department of Public Health upon receipt of my payment.

I have read and understand the above statement.