Appendix D AF Form 848.pdf

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Attached to
Potable Water Backflow Prevention Survey
Solicitation number
FA462625Q0017
Issued by

About this file

The file is an Air Force Form 848, a survey document for Cross-Connection Control and Backflow Prevention Devices. The form provides a detailed template for documenting cross-connection hazards, device types, and installation locations across various facilities. It includes specific codes for cross-connection types (such as Back Pressure, Back Siphonage) and device types (Reduced Pressure, Double Check, Pressure Vacuum Breaker), with fields for capturing device details like serial numbers, installation locations, and potential contaminants. The form is designed to comprehensively catalog and track backflow prevention equipment, supporting the Air Force's water system safety protocols.

The associated federal contract opportunity (Solicitation FA462625Q0017) seeks a contractor to conduct a cross-connection control survey at Malmstrom Air Force Base in Montana, including the main base and 15 remote Missile Alert Facilities. The contractor will be responsible for providing labor, hardware, equipment, and incidentals to perform a full survey of the potable water system, with the Department of the Air Force Global Strike Command as the sponsoring agency. The survey aims to identify and document potential water system cross-connection risks and backflow prevention measures.

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HOST BASE NAME

INSTALLATION NAME

SURVEY of CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

AREA ID NO.

FACILITY ID NO.

HAZARD

(CONTAMINANT

OR

COMMENTS

DEVICE

CROSS CONNECTION

CROSS CONNECTION

ID NO.

DEVICE TYPE

POLLUTANT)

CODES

TYPE

REQUIRED.

INSTALLED

LOCATION NO.

SERIAL NO.

CROSS CONNECTION TYPE: BP - Back Pressure, BS - Back Siphonage, CROSS CONNECTION CODES: HB - Hose Bibb with Hose, CM - Chemical Make Up, BM - Boiler System Make Up, FS-Fire Sprinkler System DEVICE TYPES: RP- Reduced Pressure, DC - Double Check, DCDA - Double check Detector Assembly, PVB - Pressure Vacuum Breaker, AVB Atmospheric Vacuum Breaker, Air Gap

AF FORM 848, 20071017

8.2.1.3158.1.475346.466429

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