Big Spring, TX · Howard County
Backflow Prevention Assembly Test and Maintenance Report
This report records testing and maintenance for a backflow prevention assembly and is completed by the technician who tests the assembly.
What this form is
The City of Big Spring requires a separate completed report for each assembly, with a signed and dated original submitted to its Permit Office for TNRCC audits. The report records assembly and property details, test results, any repairs and materials used, gauge information, technician certification, and the technician’s signature and date. Illegible or incomplete reports will not be accepted.
Who needs it
A backflow technician who tests and maintains an assembly must complete this report for each assembly and certify the information.
How to submit it
Submit a signed and dated original to the City of Big Spring Permit Office at 217 E 3rd St., Big Spring, TX 79720.
About notarization
This report is signed and dated without a notary; the technician certifies the information and signs and dates the report.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report.
- 2
Complete The Assembly Details
Fill in the assembly, occupant or business, property, installation reason, and assembly type information.
- 3
Record Tests And Repairs
Enter test results, repairs and materials used, gauge details, and the technician’s certification.
- 4
Sign And Date The Report
The backflow technician must print their name, sign, and date the report.
- 5
Submit The Original
Submit the signed and dated original to the City of Big Spring Permit Office.
Frequently asked questions
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The report has a technician certification and signature line, but no notary block. The technician signs and dates the report.
- How do I submit the Backflow Prevention Assembly Test and Maintenance Report?
- Submit a signed and dated original to the City of Big Spring Permit Office at 217 E 3rd St., Big Spring, TX 79720.
- Does each backflow assembly need its own report?
- Yes. The form states that a report must be completed for each assembly.
- What information does the report request?
- It asks for assembly and property details, test results, repairs and materials used, gauge information, and the technician’s certification, signature, and date.