Tolar, TX · Hood County
Backflow Prevention Assembly Test and Maintenance Report
Licensed testers use this report to document backflow assembly testing and maintenance and provide the signed original to the City of Tolar’s public water supplier.
What this form is
This report records the test and maintenance results for a backflow prevention assembly and is completed for each assembly tested. The licensed tester records assembly details, test results, gauge information, and remarks, then signs and dates the report. The signed original must be submitted to the public water supplier for recordkeeping, and all pages must be provided if the report runs more than one page.
Who needs it
A licensed tester who tests or maintains a backflow prevention assembly serving the City of Tolar’s public water system completes this report.
How to submit it
Submit the signed and dated original to the public water supplier at P.O. Box 100, Tolar, Texas, 76476. The form identifies the City of Tolar as the public water supplier.
About notarization
This document is signed and dated by the licensed tester without a notary; the form does not identify any 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.
- 2
Complete the Report
Complete one report for each assembly tested, recording assembly details, test results, gauge information, and remarks.
- 3
Sign and Date
The licensed tester who performed the work signs and dates the report.
- 4
Submit to the Public Water Supplier
Provide the signed original to the public water supplier at P.O. Box 100, Tolar, Texas, 76476.
Frequently asked questions
- What is the Backflow Prevention Assembly Test and Maintenance Report for?
- It documents the test and maintenance results for a backflow prevention assembly. The form must be completed for each assembly tested.
- Who completes the backflow test report?
- The licensed tester who performed the testing completes and signs the report. Testing by a different tester must be documented on a separate form.
- Do I need a notary for the Backflow Test Report?
- No. The licensed tester signs and dates the report without a notary; the form does not identify an attachment or related step that must be notarized or sworn.
- How do I submit the Backflow Test Report?
- Provide the signed and dated original to the public water supplier at P.O. Box 100, Tolar, Texas, 76476. Submit all pages if the report is more than one page.