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Run: ASSE Backflow Tester Certification and Gauge Calibration Log

Track ASSE backflow tester certification, test kit serial numbers, gauge calibration, and jurisdictional registration in one audit-ready log. Use it to verif...

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Tester Identification

Tester Name (required)

ASSE 5110 Certification Number (required)

Enter the tester's ASSE 5110 certification number as shown on the credential.

Certification Expiration Date (required)

Test Kit and Gauge Information

Test Kit Serial Number (required)

Test Kit Manufacturer

Gauge Calibration Certificate Number (required)

Record the annual calibration certificate number for the gauge/test kit.

Gauge Calibration Date (required)

Gauge Calibration Expiration Date (required)

Jurisdictional Registration

Jurisdiction / Authority Having Jurisdiction (AHJ) (required)

Jurisdictional Registration Number

Registration Status (required)

Registration Expiration Date

Renewal and Audit Notes

Last Verified Date

Verification Notes

Add any compliance notes, renewal reminders, or exceptions. Do not include unnecessary PII.

Supporting Document

Upload a copy of the certification card, calibration certificate, or registration document.

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Email (required)

Your name (optional)

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