Sunnyvale, TX · Dallas County
Backflow Prevention Assembly Test and Maintenance Report
This report records testing and maintenance of a backflow prevention assembly and is completed by the certified tester for each assembly tested.
What this form is
The Town of Sunnyvale report records test and maintenance results for a backflow prevention assembly. The form must be completed for each assembly tested, including annual tests, new installations, or replacements. It asks for business and assembly details, test results, repairs, gauge calibration information, and the certified tester’s information and signature.
Who needs it
A certified tester completes this report for each backflow prevention assembly tested and provides it to the public water supplier.
How to submit it
Submit a signed and dated original to the public water supplier for record keeping purposes. The form lists the Town of Sunnyvale address as 127 N. Collins Rd., Sunnyvale, TX 75182.
About notarization
This report is signed and dated without a notary; the document does not list any 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 Test Details
Enter the assembly, test results, repairs, gauge, firm, and certified tester information.
- 3
Sign and Date the Report
The tester signs and dates the completed report. The form does not list any required attachments.
- 4
Submit the Original
Submit the signed and dated original to the public water supplier for record keeping.
Frequently asked questions
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The report calls for the tester’s signature and date, but it does not require a notary or list any notarized or sworn attachment.
- How do I submit the backflow test report?
- Submit a signed and dated original to the public water supplier for record keeping purposes, as directed by the form.
- When must this report be completed?
- The form says it must be completed for each assembly tested and includes options for annual tests, new installations, and replacements.
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.