Who completes the Backflow Prevention Assembly Test and Maintenance Report?

The report requests the licensed tester’s name, signature, license number, company information, and test results. It must be completed for each assembly tested.

Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?

No. This report has no notary block or notarized attachment; the licensed tester signs and dates it.

What information does the report ask for?

It asks for assembly and property details, test results, repairs and materials used, gauge information, and the licensed tester’s and company’s information.

Copperas Cove, TX · Coryell County

No notary required

Backflow Prevention Assembly Test and Maintenance Report

Licensed testers complete this report for each backflow prevention assembly tested and submit it to the public water supplier for recordkeeping.

What this form is

The report records the assembly type and location, test results, repairs, and the licensed tester’s information. The form says it must be completed for each assembly tested and that a signed and dated original must be submitted to the public water supplier for recordkeeping.

Who needs it

A licensed tester completes and submits this report for each backflow prevention assembly tested.

How to submit it

Submit a signed and dated original to the public water supplier for recordkeeping. The form lists the City of Copperas Cove, 914 Tank Street, Copperas Cove, TX 76522.

About notarization

This report is signed and dated without a notary; it identifies no notarized or sworn attachment, so the licensed tester just signs and dates it.

How to submit this form

1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report PDF.
2
Complete The Report
Complete a report for each assembly tested, including assembly details, test results, and licensed tester information.
3
Sign And Date
The licensed tester signs and dates the report and certifies the information as true at the time of testing.
4
Submit The Original
Submit the signed and dated original to the public water supplier for recordkeeping at the address listed on the form.

Frequently asked questions

Who completes the Backflow Prevention Assembly Test and Maintenance Report?: The report requests the licensed tester’s name, signature, license number, company information, and test results. It must be completed for each assembly tested.
How do I submit the Backflow Prevention Assembly Test and Maintenance Report?: Submit a signed and dated original to the public water supplier for recordkeeping. The form lists the City of Copperas Cove at 914 Tank Street, Copperas Cove, TX 76522.
Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?: No. This report has no notary block or notarized attachment; the licensed tester signs and dates it.
What information does the report ask for?: It asks for assembly and property details, test results, repairs and materials used, gauge information, and the licensed tester’s and company’s information.

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.