Cross Connection Sheets.pdf
PDF 7 MB Posted
- Solicitation number
- 36C25622R0067
About this file
This document contains cross connection sheets for the Overton Brooks VAMC Upgrade Water Distribution System project to improve Legionella prevention. It identifies 51 existing backflow cross connection sources according to codes and regulations, including hose bibbs, spigots, threaded faucets, soap dispensers, and drain pipes located throughout the basement and 11 floors of the main hospital building. Each cross connection is photographed and numbered, with comments recommending replacement of non-compliant fixtures with vacuum breakers or in-line devices to prevent potential contamination from backsiphonage. The related federal contract opportunity posting seeks project number 667-19-101 to upgrade the water distribution system at the Overton Brooks VA Medical Center to improve Legionella prevention in cooling towers and storage tanks, issued by the Department of Veterans Affairs Veterans Health Administration VISN 16.
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Text version
Overton Brooks VAMC Upgrade Water Distribution System
To Improve Legionella Prevention, Cooling Towers & Storage Tanks
1-SUB-4-001
Sub Basement
Hose
Backsiphonage
1/PL-106
02/27/2020 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Piping connections to a potential backsiphonage source from submergence of hose in a contaminated source and unprotected hose bibb. Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
Image Not Available
©Northeast Infrastructure, LLC 2021
Cooling Towers & Storage Tanks
1-SUB-4-002
Sub Basement
Closed Valve
Backsiphonage
1/PL-101
04/08/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Cooling Towers & Storage Tanks
1-SUB-STAIRS-001
Sub Basement
Stairs
Spigot
Backsiphonage
1/PL-105
02/27/2020 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
Cooling Towers & Storage Tanks
1-SUB-STAIRS-002
Sub Basement
Stairs
Spigot
Backsiphonage
1/PL-106
02/27/2020 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
Cooling Towers & Storage Tanks
1-B-D11-001
Basement
D11
Hose
Backsiphonage
1/PL-110
04/08/2019
Piping connections to a potential backsiphonage source from submergence of hose in a contaminated source and unprotected hose bibb. Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Picture of Potential Cross Connection
8046-7
Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-B-E23A-001
Basement
E23A
Mop Sink
Backsiphonage
1/PL-108
11/06/2019
1643-4
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Picture of Potential Cross Connection
Cooling Towers & Storage Tanks
1-B-N6-001
Basement
N6
Multiple Hoses
Backsiphonage
1/PL-109
04/08/2019
Dual piping connections to a potential non-potable water usage reprentsents a cross contamination risk due to either backpressure or backsiphonage backflow, potential high hazard source. Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Picture of Potential Cross Connection
Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-B-N6-002
Basement
N6
Hose
Backsiphonage
1/PL-109
04/08/2019
Picture of Potential Cross Connection
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Floor:
Room Number:
Case Number:
Device:
Hazard:
Piping connections to a potential backsiphonage source from submergence of hose in a contaminated source.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Drawing Reference #:
Date of Survey:
Cooling Towers & Storage Tanks
1-B-N10-001
Basement
N10
Hose
Backsiphonage
1/PL-109
04/10/2019
Picture of Potential Cross Connection
Date of Survey:
674-75
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Piping connections to a potential backsiphonage source from submergence of hose in a contaminated source and unprotected hose bibb. Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-B-N10-002
Basement
N10
Soap Dispenser
Backsiphonage
4/PL-113
04/10/2019
Picture of Potential Cross Connection
Date of Survey:
576-77
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Piping connections to a potential backsiphonage source from submergence of hose in a contaminated source or backsiphonage from soap dispenser. Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-B-N10-003
Basement
N10
Soap Dispenser
Backsiphonage
4/PL-113
04/10/2019
Picture of Potential Cross Connection
Date of Survey:
682-83
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-B-N10-004
Basement
N10
Soap Dispenser
Backsiphonage
1/PL-113
04/10/2019
Picture of Potential Cross Connection
Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Piping connections to a potential backsiphonage source from submergence of hose in a contaminated source or backsiphonage from soap dispenser. Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-B-S2-001
Basement
S2
Soap Dispenser
Backsiphonage
1/PL-111
11/06/2019
1639-40
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to have a broken atmospheric vacuum breaker upstream of the faucet, and presents a potential cross connect hazard.
Recommendation is to replace atmospheric vacuum breaker with new atmospheric vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-B-Outside-001
Basement
Outside
Spigot
Backsiphonage
1/PL-112
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1442-43
Cooling Towers & Storage Tanks
1-B-Outside-002
Basement
Outside
Spigot/Hose
Backsiphonage
1/PL-112
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1412-3
Cooling Towers & Storage Tanks
1-B-Outside-003
Basement
Outside
Spigot/Hose
Backsiphonage
1/PL-109
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1416-8
Cooling Towers & Storage Tanks
1-B-Outside-004
Basement
Outside
Spigot/Hose
Backsiphonage
1/PL-109
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1416-8
Cooling Towers & Storage Tanks
1-B-Outside-005
Basement
Outside
Spigot
Backsiphonage
1/PL-109
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1414-5
Cooling Towers & Storage Tanks
1-B-Outside-006
Basement
Outside
Spigot
Backsiphonage
1/PL-112
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1437-9
Cooling Towers & Storage Tanks
1-B-Outside-007
Basement
Outside
Spigot
Backsiphonage
1/PL-111
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1435-6
Cooling Towers & Storage Tanks
1-B-Outside-008
Basement
Outside
Spigot
Backsiphonage
1/PL-111
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1430-2
Cooling Towers & Storage Tanks
1-B-Outside-009
Basement
Outside
Spigot
Backsiphonage
1/PL-111
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1433-4
Cooling Towers & Storage Tanks
1-B-Outside-010
Basement
Outside
Spigot
Backsiphonage
1/PL-111
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1428-9
Cooling Towers & Storage Tanks
1-1-E300C-001
E300C
Soap Dispenser
Backsiphonage
7/PL-119
11/06/2019
1630-1
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-1-S2-001
S2
Soap Dispenser
Backsiphonage
1/PL-118
11/06/2019
1632-3
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-1-Outside-001
Outside
Spigot
Backsiphonage
5/PL-119
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1419-20
Cooling Towers & Storage Tanks
1-1-Outside-002
Outside
Spigot
Backsiphonage
1/PL-117
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1421-22
Cooling Towers & Storage Tanks
1-1-Outside-003
Outside
Spigot
Backsiphonage
1/PL-117
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing outside spigot appears to be protected with an existing in-line vacuum breaker. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1423-5
Cooling Towers & Storage Tanks
1-1-Outside-004
Outside
Spigot/Hose
Backsiphonage
1/PL-117
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1426-7
Cooling Towers & Storage Tanks
1-1-Outside-005
Outside
Spigot
Backsiphonage
1/PL-118
08/29/2019 Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Broken Spigot - Potential Dead Leg Hazard.
The subject spigot is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace spigot with new spigot incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Picture of Potential Cross Connection
1440-1
Cooling Towers & Storage Tanks
1-2-E101-001
E101
Spigot
Backsiphonage
1/PL-123
11/06/2019
Picture of Potential Cross Connection
Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject spigot is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-2-N8-001
N8
Threaded Faucet
Backsiphonage
1/PL-122
11/06/2019
Picture of Potential Cross Connection
Date of Survey:
1624-5
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject faucet is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace faucet with new faucet incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-2-N19-001
N19
Drain Pipe
Backsiphonage
1/PL-122
08/28/2019
Picture of Potential Cross Connection
Date of Survey:
1354-6
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-2-S36-001
S36
Soap Dispenser
Backsiphonage
1/PL-124
11/06/2019
Picture of Potential Cross Connection
Date of Survey:
1636-7
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-2-W11-001
W11
Soap Dispenser
Backsiphonage
2/PL-124
08/28/2019
Picture of Potential Cross Connection
Date of Survey:
1345-9
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-E13-001
E13
Soap Dispenser
Backsiphonage
1/PL-132
08/24/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N7-001
N7
Spigot
Backsiphonage
1/PL-128
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N11-001
N11
Spigot
Backsiphonage
4/PL-131
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
111512
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N13-001
N13
Spigot
Backsiphonage
1/PL-128
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N14-001
N14
Spigot
Backsiphonage
1/PL-128
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N15-001
N15
Spigot
Backsiphonage
5/PL-131
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N16-001
N16
Spigot
Backsiphonage
5/PL-131
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N19-001
N19
Spigot
Backsiphonage
1/PL-128
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-N20-001
N20
Spigot
Backsiphonage
1/PL-128
06/17/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-3-N11-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing spigot appears to be protected with an existing in-line vacuum breaker upstream of the faucet.
Recommended replacement and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-3-W60A-001
W60A
1 1/4" galvanized/steel piping
Cross-Contamination
1/PL-131
06/16/2019
Picture of Potential Cross Connection
Date of Survey:
115405-115437
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Recommendation is to remove galvanized water piping and replace with copper piping. See drawing 1/PL-131 for full note on galvanized domestic water piping.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-4-E20G-001
E20G
Threaded Faucet
Backsiphonage
6/PL-135
06/15/2019
Picture of Potential Cross Connection
Date of Survey:
083242-083246
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-4-E20G-002
E20G
Threaded Faucet
Backsiphonage
6/PL-135
06/15/2019
Picture of Potential Cross Connection
Date of Survey:
083242-083246
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-4-N3-001
N3
Soap Dispenser
Backsiphonage
1/PL-133
11/06/2019
1610-1
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-4-W34-001
W34
Spigot
Backsiphonage
3/PL-134
06/13/2019
Picture of Potential Cross Connection
Date of Survey:
180515
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject hose bibb is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace hose bibb with new hose bibb incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-5-E3-001
E3
Slop Sink
Backsiphonage
1/PL-136
11/06/2019
Picture of Potential Cross Connection
Date of Survey:
1595-6
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-5-W33-001
W33
Soap Dispenser
Backsiphonage
1/PL-136
06/11/2019
Picture of Potential Cross Connection
Date of Survey:
181445-181452
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N4-001
N4
Soap Dispenser
Backsiphonage
1/PL-139
11/06/2019
1582-3
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-6-N8-001
N8
Threaded Faucet
Backsiphonage
1/PL-140
11/06/2019
1585-6
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-6-N10-001
N10
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N12-001
N12
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N17-001
N17
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N19-001
N19
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N22-001
N22
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N23-001
N23
Threaded Faucet
Backsiphonage
4/PL-142
11/06/2019
1589-90
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject faucet is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace faucet with new faucet incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-6-N24-001
N24
Threaded Faucet
Backsiphonage
4/PL-142
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N25-001
N25
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
1329-31
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-6-N26-001
N26
Threaded Faucet
Backsiphonage
1/PL-140
11/06/2019
Picture of Potential Cross Connection
Date of Survey:
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject faucet is not provided with required backflow prevention for backsiphonage (vacuum breaker), and present a potential cross connect hazard.
Recommendation is to replace faucet with new faucet incorporating a vacuum breaker, or use an in-line vacuum breaker.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N27-001
N27
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
All sink in these rooms are equipted with the same spigot assembly as 1-6-N8-001, 1-6-N25-
001, and 1-6-N28-001
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-6-N28-001
N28
Threaded Faucet
Backsiphonage
1/PL-140
08/27/2019
1337-9
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Drawing Reference #:
Date of Survey:
Cross Connection Identification
Cooling Towers & Storage Tanks
1-7-E7A-001
E7A
Soap Dispenser
Backsiphonage
2/PL-144
11/06/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
Bao Phone 003
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-7-N13B-001
N13B
Soap Dispenser
Backsiphonage
1/PL-144
11/06/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
Bao Phone 004
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-7-W27-001
W27
Soap Dispenser
Backsiphonage
1/PL-143
11/06/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
Bao Phone 001
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-7-W55-001
W55
Slop Sink
Backsiphonage
1/PL-143
08/28/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
1357-60
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-8-W60-001
W60
Drain Pipe
Backsiphonage
2/PL-149
08/29/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject is not provided with required backflow prevention for backsiphonage, and present a potential cross connect hazard. Recommendation is to install check valve and provide an appropriate air gap for drain piping.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-8-W60-002
W60
Drain Pipe
Backsiphonage
2/PL-149
08/29/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject is not provided with required backflow prevention for backsiphonage, and present a potential cross connect hazard. Recommendation is to install check valve and provide an appropriate air gap for drain piping.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-8-W60-003
W60
Drain Pipe
Backsiphonage
2/PL-149
08/29/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject is not provided with required backflow prevention for backsiphonage, and present a potential cross connect hazard. Recommendation is to install check valve and provide an appropriate air gap for drain piping.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-8-W60-004
W60
Drain Pipe
Backsiphonage
2/PL-149
08/29/2019
Picture of Potential Cross Connection
Date of Survey:
Image Not Available
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
The subject is not provided with required backflow prevention for backsiphonage, and present a potential cross connect hazard. Recommendation is to install check valve and provide an appropriate air gap for drain piping.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-9-E4-001
E4
Soap Dispenser
Backsiphonage
2/PL-153
08/23/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
1231-6
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-9-N4-001
N4
Soap Dispenser
Backsiphonage
1/PL-155
08/25/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
1259-63
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-9-W22-001
W22
Soap Dispenser
Backsiphonage
1/PL-152
08/25/2019
Picture of Potential Cross Connection
Date of Survey:
1280-2
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-10-E22-001
E22
Soap Dispenser
Backsiphonage
2/PL-157
08/27/2019
Picture of Potential Cross Connection
Date of Survey:
1339-42
Cross Connection Identification
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-10-N2-001
N2
Soap Dispenser
Backsiphonage
1/PL-156
08/23/2019
Picture of Potential Cross Connection
Cross Connection Identification
Date of Survey:
1222-6
Identification of existing backflow cross connection sources per Codes and Regulations as provided in original VA SOW
Description
Cross Connection Number: Comments / Recommendations
Building Number:
Existing sink faucet water source appears to be protected with an existing atmospheric vacuum breaker upstream of the faucet. Recommended inspection and verification of proper operation.
Floor:
Room Number:
Case Number:
Device:
Hazard:
Cooling Towers & Storage Tanks
1-11-C1-001
C1
Spigot/Hose
Backsiphonage
2/PL-158
06/27/2019
Picture…
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