Standard Forms

• Application for Recycled Water Service (MS Word Document, 528 KB)
  Customers complete this form to provide all customer contact information and submit it with your project design plans to your recycled water retailer.
• Cross Connection Certification Form (MS Word Document, 45 KB)
  AWWA cross-connection specialists complete this form to document that a site has passed the required cross-connection test, performed in coordination with the SBWR inspector.
• Construction Inspection Checklist (MS Word Document, 176 KB)
  South Bay Water Recycling Program inspectors complete this form to document that all construction and regulatory requirements have been met.

Annual Site Inspection Report
Certified site supervisors are required to complete this form and return it to the South Bay Water Recycling Program annually. Select the form that corresponds to your water retailer from the list below. Forms are in PDF format.

City of Milpitas

• Cooling Tower (PDF, 48 KB)
• Industrial (PDF, 48 KB)
• Irrigation (PDF, 47 KB)
• Multi-Use (PDF, 49 KB)

City of Santa Clara

• Cooling Tower (PDF, 49 KB)
• Industrial (PDF, 48 KB)
• Irrigation (PDF, 48 KB)
• Multi-Use (PDF, 49 KB)

San Jose Municipal Water

• Cooling Tower (PDF, 48 KB)
• Industrial (PDF, 47 KB)
• Irrigation (PDF, 46 KB)
• Multi-Use (PDF, 48 KB)

San Jose Water Company

• Cooling Tower (PDF, 49 KB)
• Industrial (PDF, 49 KB)
• Irrigation (PDF, 48 KB)
• Multi-Use (PDF, 50 KB)

Conductivity Tester Instructions
Each site supervisor has been provided a conductivity tester as a tool to help them determine the difference between recycled water and potable water. The site supervisor will need to understand how to operate this tester in order to answer question #8 of the annual site inspection report. This tester should be used on a regular basis, to help ensure that potable and recycled water distribution systems remain separated as required by the California Department of Public Health.

• Conductivity Tester Instructions (PDF, 389 KB)
  

For further assistance, call (408) 277-3671.

Updated: 5/17/12

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