Harker Heights, TX · Bell County
Backflow Prevention Assembly Test and Maintenance Report
Licensed testers use this report to record backflow prevention assembly test and maintenance results and provide them to the City of Harker Heights water system.
What this form is
The report documents testing and maintenance for each backflow prevention assembly tested. The instructions say a completed report must be provided to the public water supplier for recordkeeping, with a signed and dated original. It asks for the assembly’s type, location, test results, repairs, gauge details, and licensed tester and company information.
Who needs it
A licensed tester who tests a backflow prevention assembly for the City of Harker Heights water system completes and submits this report.
How to submit it
Provide the signed and dated original, including all report pages, to the public water supplier at 305 Miller’s Crossing, Harker Heights, Texas 76548.
About notarization
This report is signed and dated by the licensed tester without a notary; the document does not mention a notarized or sworn attachment.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report.
- 2
Complete The Report
Complete the report while testing is occurring, recording the assembly, test results, gauge, repairs, and tester information.
- 3
Sign And Date
The licensed tester who performed the work must sign and date the report.
- 4
Submit The Report
Provide the signed and dated original and all report pages to the public water supplier at the address listed on the form.
Frequently asked questions
- What is the Backflow Prevention Assembly Test and Maintenance Report?
- It records test and maintenance results for a backflow prevention assembly and provides information about the assembly, gauge, repairs, and licensed tester.
- Who completes this report?
- A licensed tester who performs the assembly test completes the report. The instructions say testing by different testers must be documented on separate forms.
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The report is signed and dated by the licensed tester without a notary; the document does not mention a notarized or sworn attachment.
- How do I submit the Backflow Prevention Assembly Test and Maintenance Report?
- Provide the signed and dated original, including all report pages, to the public water supplier at 305 Miller’s Crossing, Harker Heights, Texas 76548.
Need something notarized?
This Backflow Prevention Assembly Test and Maintenance Report doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.