Do I need a notary for the TCEQ backflow test report?

No. The licensed tester signs and dates the report; the form does not specify a notarized or sworn attachment.

Who completes the backflow test report?

A licensed tester who performs the assembly test completes the report. Testing for each assembly must be documented on its own form.

When should the report be completed?

The form is intended to be completed on-site while testing is occurring. If completed electronically, the device must also be on-site.

Tolar, TX · Hood County

No notary required

TCEQ Backflow Prevention Assembly Test and Maintenance Report

Licensed testers use this report to document a backflow prevention assembly test and provide the completed record to the public water supplier.

What this form is

This report records the results of testing and maintaining a backflow prevention assembly, including assembly details, test readings, repairs, gauge information, and licensed tester information. A separate form is required for each assembly tested, and the report is completed on-site while testing occurs. The licensed tester signs and dates the report, and the signed original is provided to the public water supplier for recordkeeping.

Who needs it

A licensed tester who tests a backflow prevention assembly completes this report and submits it to the public water supplier.

How to submit it

The licensed tester must sign and date the report and provide the hardcopy original to the public water system. Submit all pages of the report to the water system.

About notarization

This document is signed and dated without a notary; the licensed tester signs the report, and no notarized or sworn attachment is specified.

How to submit this form

1
Download The Report
Download the TCEQ Backflow Prevention Assembly Test and Maintenance Report.
2
Complete The Form On-Site
Record the assembly details and test results while testing occurs; use a separate form for each assembly.
3
Sign And Date The Report
The licensed tester who performed the work signs and dates the report.
4
Submit The Original
Provide the signed hardcopy original and all report pages to the public water system.

Frequently asked questions

Do I need a notary for the TCEQ backflow test report?: No. The licensed tester signs and dates the report; the form does not specify a notarized or sworn attachment.
How do I submit the backflow test report?: The licensed tester must sign and date the report and provide the hardcopy original to the public water system. Submit every page of the report to the water system.
Who completes the backflow test report?: A licensed tester who performs the assembly test completes the report. Testing for each assembly must be documented on its own form.
When should the report be completed?: The form is intended to be completed on-site while testing is occurring. If completed electronically, the device must also be on-site.

Need something notarized?

This TCEQ 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.