Hickory Creek, TX · Denton County
Backflow Prevention Assembly Test and Maintenance Report
Certified testers complete this report to document testing and maintenance of a backflow prevention assembly and return a copy to Lake Cities Municipal Utility Authority.
What this form is
This report records a backflow prevention assembly test and maintenance, and certifies that the assembly was operating within acceptable parameters at the time of testing. After performing the test, the tester records the water system and service location, assembly details, test results, repairs, gauge information, and certification details. The document says to return a copy to Lake Cities Municipal Utility Authority.
Who needs it
A certified tester completes this report after testing and maintaining a backflow prevention assembly.
How to submit it
After the test, return a copy to Lake Cities Municipal Utility Authority, as directed on the report.
About notarization
This document is signed and dated without a notary; it identifies no attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report PDF.
- 2
Complete The Report
Record the water system, service location, assembly details, test results, repairs, gauge information, and tester certification.
- 3
Return A Copy
After the test, return a copy to Lake Cities Municipal Utility Authority, as directed on the report.
Frequently asked questions
- Who completes the Backflow Prevention Assembly Test and Maintenance Report?
- A certified tester completes the report after testing and maintaining a backflow prevention assembly, recording the results and certification details.
- How do I submit the report?
- After the test, return a copy to Lake Cities Municipal Utility Authority, as directed on the report.
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The report is signed and dated without a notary, and it identifies no attachment or related step that must be notarized or sworn.
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.