B08_Solicitation-SOW-Attachment_BFI_Form.pdf

This is a template form for documenting the testing and maintenance of backflow prevention assemblies used within National Park Service facilities. Form BF-1 serves as the official record for certifying that backflow prevention devices meet safety and operational standards.

The form captures general information about the assembly including the facility address, FMSS Asset ID, installation date, incoming line pressure, manufacturer details, model number, serial number, size, and assembly type (RP, RP Detector, DC Detector, or PVB). Section II documents initial and final test results for three critical components: Check Valve No. 1, Check Valve No. 2, and the Differential Pressure Relief Valve. The form records whether valves leaked or closed tight, specific pressure drop measurements across check valves, and the pressure at which the relief valve opened. A repairs section allows documentation of any corrections made to failed components between initial and final testing. Section III requires approval signatures and credentials from the certified technician performing the work, including company name, address, phone number, certificate number, and gauge number, as well as final approval from the Regional Structural Fire Management Officer or designee. The form concludes with a pass/fail determination for the overall assembly.