Cross Connection Forms

New or Replacement Backflow Device

Cross-Connection Control Program:
New or Replacement Backflow Device

1Check one the boxes below:
2Fill-out the facility and device information below:
3New Backflow Device Detail:
4Type of Service (select one of the following):
5Type of Protection (select one of the following):
6Description of Device Location
7Provide the device test information below:
SINGLE CHECK        
DOUBLE CHECK VALVE ASSEMBLY   SPILL RESISTANT VACUUM BREAKER

REDUCED PRESSURE PRINCIPLE ASSEMBLY

PRESSURE VACUUM BREAKER
CHECK VALVE NO. 1 CHECK VALVE NO. 2 DIFFERENTIAL RELIEF VALVE AIR INLET VALVE CHECK VALVE
HELD AT: HELD AT: OPENED AT: OPENED AT: HELD AT:
CLOSED TIGHT (RP) CLOSED TIGHT (RP) DID NOT OPEN DID NOT OPEN  
LEAKED LEAKED     LEAKED

 

Correction of Facility/Device Information

Cross-Connection Control Program:
Correction of Facility/Device Information

1Correction of Facility/Device Information
2Requested Change
3Type of protection
4Request submitted by

 


Cross Connection Frequently Asked Questions

What is currently available in the system for Cross-Connection users?
Cross-Connection users can execute the following actions in Citizen Access:
  • Look up device information (i.e. BD records);
  • Look up and print backflow tests (i.e. BDT records) that have been submitted to the County; and
  • Submit annual backflow tests to the County (only for users who are Certified Professionals).
Do you have a mobile-friendly app to submit backflow tests?

Yes, we do! We have a mobile app available for both Apple and Android tablets and smart phones. You can download the app in the Google Play Store (for Android) or Apple Store (for Apple products like iPhone or iPad) by searching "Backflow Test".

To login to the mobile app, you need a Citizen Access account and it must be linked to your Certified Professional (CI#) number. Additionally, if your CI license is expired, you must renew your license with the County’s Environmental Health Division in order to login to the mobile apps.

If you need assistance in linking your Citizen Access account to your Certified Professional license, see section titled, "I am a Certified Professional. How do I link my Citizen Access account with my Certified Professional (CI) number?"

I’m having difficulty viewing information from Citizen Access. What is the issue?

If the website images are cut-off or you cannot see pop-up windows, this means that the version of your internet browser may be incompatible with Citizen Access.

An Internet browser is a program that you use to access the internet on your computer to view webpages, such as Internet Explorer, Mozilla Firefox, Google Chrome, Safari, or Opera. Please see the FAQ page titled, "Web Browser Requirements", to determine if your internet browser will need to be upgraded.

Additionally, Citizen Access does not have a mobile-friendly version for smart phones and tablets; as a result, you will have difficulty navigating this website on your mobile device. However, please note that we are currently developing a mobile-friendly app for our Cross-Connection users, and we will let you know when this mobile app is ready to be used.

If you continue to run into technical issues, please contact the Citizen Access Technical Support Team.

How do I look up device information and print the test report?
  1. Login to Citizen Access.
  2. Click on the "More" tab and select "Env Health".
  3. Type in the device number (BD) or backflow test (BDT) number in the Record Number field and click Search. Please note that you do not have to fill-out any other search field if you have the device number or backflow test number.

    Or, you can do a reverse look-up by using the Facility ID (FN). Type in the Facility ID in the Record Number field and click Search

    The system will pull up the Facility record detail page. On this page, navigate to the Related Records section and click on the arrow next to the section header. You will see all of the records associated to that particular facility.

  4. Once you are on the BD or BDT record detail page, you can click on the Report menu at the top of the page, or click on Print/View Record in the middle of the page, as shown below.

    If you cannot see the report, please make sure your internet browser security is allowing pop-up windows to appear in Citizen Access.

How do I submit backflow tests using Citizen Access?

In order to submit backflow tests in Citizen Access, you must be a Certified Professional, and your Citizen Access account must be linked to your CI license number. Please see the section titled “I am a Certified Professional. How do I link my Citizen Access account with my Certified Professional (CI) number?” for more information.

To submit a backflow test using Citizen Access, please execute the following steps:

  1. Login to Citizen Access.
  2. Place your mouse over the More tab, and click on the Env Health link, as shown below:

  3. In the Env Health module, click on the Create an Application hyperlink.

  4. Read the General Disclaimer. Then, click on the checkbox next to the text that says, “I have read and accepted the above terms,” and click on Continue Application.

  5. You will be prompted to add your Certified Professional (CI number). In the Licenses drop-down, select the CI number associated to your account and click Continue Application. If there is no CI number in this drop-down, please see “I am a Certified Professional. How do I link my Citizen Access account with my Certified Professional (CI) number?”

  6. The CI number that you selected in Step 5 will appear again for confirmation. If the CI number is correct, click Continue Application.

  7. The next page is where you will be entering the test results. First, you must type in the BD number in the Device ID field.

    Once you have entered the BD number and move your mouse cursor out of the Device ID field, the form will begin to change:

    1. the test fields below will be suppressed based on the entered BD’s device type in order to display the fields that need to be filled out, and
    2. some of the fields related to the device will be autopopulated from the BD record, which are greyed out and cannot be edited.

    If the BD is not ready to be tested or doesn’t exist in the system, you will see the following message:

    If you have any questions about the backflow device, please contact the County’s Environmental Health Division.

  8. Once you have typed the BD number and verified the device information, type in the test results in the appropriate fields and click Continue Application. The system has been programmed to indicate which values are considered a passing or failing test, which are shown in the Test Passed and Test Failed checkboxes.

    In addition to the test results, fill-out the other required fields such as Test Date and (if the device was repaired) Repaired checkbox.

  9. The next page will display all of the information that was previously entered. Please verify and confirm that the information is correct, and then click Continue Application. If you need to edit any information, click on any of the Edit buttons next to each section.

  10. You will receive a confirmation message that the application was submitted successfully. At the bottom of the page, you have the backflow test record number (with a BDT acronym) and you can print out a report for your records.

I am a Certified Professional. How do I link my Citizen Access account with my Certified Professional (CI) number?

In order to submit backflow tests, your Citizen Access account needs to be validated with your Certified Professional (CI number) information.

To determine if your Citizen Access account has already been validated by County staff, please execute the following steps:

  1. Login to Citizen Access.
  2. Click on Account Management, which is located in between the Shopping Cart and Logout hyperlinks.

  3. If you scroll down to the section titled, “License Information,” your CI information will be listed and the Status should say “Approved”, as displayed below:

    If your CI information isn’t displayed or if the status is “Pending”, please contact the County’s Environmental Health Division.

I started filling out a backflow test in Citizen Access and clicked on Save and Resume Later. Where can I find the backflow test that I was previously working on?

While filling out the backflow test, you can click on “Save and Resume Later” if you wish to hold off on submitting the information to the County’s Environmental Health Division.

To complete the backflow test that you saved, please follow the steps below:

  1. Login to Citizen Access.
  2. Place your mouse over the More tab, and click on the Env Health link, as shown below:

  3. In the Env Health module, you will see a list of Records that your account is associated to. Any entry with the abbreviation “TMP” in the Record Number column is a backflow test that was temporarily saved in Citizen Access.

    Find the appropriate application in the list and click on the Resume Application hyperlink. This will take you back to the backflow test form.

How do I submit corrections to an existing Cross-Connection record?

If you will like to correct any information to an existing Environmental Health Division’s Cross-Connection Program record, such as a facility record (FN), backflow device record (BD), or backflow test record (BDT), then use the fillable form below to submit your changes. Once you have filled out the form, click Submit and it will be sent to the County’s Environmental Health Division for follow-up.

If you have any questions regarding any Cross-Connection record information, please contact the County’s Environmental Health Division.

How do I submit information on a new or replacement backflow device?

If you are a Certified Professional who would like to submit test information for a new or replacement backflow device, please use the online form titled, "New or Replacement Backflow Device", which is located on this page in the Cross Connection Forms section. Once you have filled out the form, click Submit and it will be sent to the County's Environmental Health Division for follow-up.

If you have any questions regarding Cross-Connection record information, please contact the County’s Environmental Health Division.




Film Permits

Instructions and forms for film permit applicants.


Cross Connection Users

Instructions for Cross-Connection users on how to navigate the system and find information related to backflow devices.




Track Your Online Payments

Information about Official Payments and their charges, and instructions on how to print a copy of your receipt or view your payment history.


Reports

Instructions on accessing reports in Citizen Access such as Planning’s Approved Zoning Clearances Report and Environmental Health’s Backflow Test Report

Building & Safety Division

3rd Floor of Hall of Administration
(805) 654-2771
800 S. Victoria Av.
Ventura CA 93009
7:30 AM – 4:30 PM

East County Office
(805) 582-8064
3855-F Alamo Street Room 2nd Floor #2019A
Simi Valley, CA. 93065
7:30 AM – 4:30 PM

Code Compliance

3rd Floor of Hall of Administration
(805) 654-2463
800 S. Victoria Av.
Ventura CA 93009
7:30 AM – 4:30 PM


County Surveyor’s Office

3rd Floor of Hall of Administration
(805) 654-2068
800 S. Victoria Av.
Ventura CA 93009
7:30 AM – 4:30 PM


PWA Development Services

3rd Floor of Hall of Administration
(805) 654-2030
800 S. Victoria Av.
Ventura CA 93009
8 AM – 4:30 PM





Planning Division

3rd Floor of Hall of Administration
(805) 654-2805
800 S. Victoria Av.
Ventura CA 93009
7:30 AM – 4:30 PM


Transportation Division

3rd Floor of Hall of Administration
(805) 654-2049
800 S. Victoria Av.
Ventura CA 93009
8 AM – 4:30 PM



Technical Support

Please use this Technical Support contact form when experiencing technical issues that aren't covered in the above Help section. Please provide all requested information. We will be in contact with you within one business day after receiving your information.



* required


* required


Describe the Issue: