2. Submit a Hazard Assessment

   Please carefully review and complete the Hazard Assessment and upload your completed forms below. Completed forms MUST include a signature. 

   For questions regarding the form or the Cross-Connection Control Program,  please contact the City's Cross Connection Specialist:

   • Phone: (408) 586-3348
   • E-mail: rmoreno@milpitas.gov or backflow@milpitas.gov

   
   

3. 

   
   

5. Download the Hazard Assessment Form
   CMP Hazard Assessment Report Form (Fillable PDF)

   Note: Form fields are fillable, but a signature is REQUIRED for submission. Please download the form and provide a signature through your preferred document editor, or provide a wet signature and upload your completed document. 

6. Upload your completed form
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8. 1. Receive an email copy of this form.
9. Email address

   This field is not part of the form submission.

10. Submit

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