Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?

No. The licensed tester signs and dates the report; the document does not list a notarized attachment or sworn step.

How do I submit the Backflow Prevention Assembly Test and Maintenance Report?

Submit the signed and dated original to the public water supplier. The form lists City of Hewitt, P.O. Box 219, Hewitt, TX 76643.

Who completes the backflow test report?

A licensed tester completes one report for each assembly tested and documents the test results, maintenance, gauge information, and tester details.

Can I complete the report electronically?

Yes. The instructions allow electronic completion on an on-site device during testing. The form must be printed and signed unless TCEQ-approved electronic recordkeeping is used.

Hewitt, TX · McLennan County

No notary required

Backflow Prevention Assembly Test and Maintenance Report

Licensed testers use this report to document backflow prevention assembly testing and maintenance and submit the completed record to the public water supplier.

What this form is

Complete a separate report for each backflow prevention assembly tested. The form records assembly details, test results, repairs, gauge information, and the licensed tester’s information; submit a signed and dated original to the public water supplier for recordkeeping. The instructions say the report is completed on-site during testing and that all pages must be submitted.

Who needs it

A licensed tester who tests or maintains a backflow prevention assembly for the public water supplier completes and submits this report.

How to submit it

Submit the signed and dated original to the public water supplier for recordkeeping; the form lists City of Hewitt, P.O. Box 219, Hewitt, TX 76643.

About notarization

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

How to submit this form

1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report.
2
Complete The Form On-Site
Complete a separate report for each assembly tested, recording assembly details, test results, gauge information, and tester details.
3
Sign And Date The Report
The licensed tester who performed the work must sign the printed form unless TCEQ-approved electronic recordkeeping is used.
4
Submit The Original
Submit the signed and dated original to the public water supplier; the form lists City of Hewitt, P.O. Box 219, Hewitt, TX 76643.

Frequently asked questions

Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?: No. The licensed tester signs and dates the report; the document does not list a notarized attachment or sworn step.
How do I submit the Backflow Prevention Assembly Test and Maintenance Report?: Submit the signed and dated original to the public water supplier. The form lists City of Hewitt, P.O. Box 219, Hewitt, TX 76643.
Who completes the backflow test report?: A licensed tester completes one report for each assembly tested and documents the test results, maintenance, gauge information, and tester details.
Can I complete the report electronically?: Yes. The instructions allow electronic completion on an on-site device during testing. The form must be printed and signed unless TCEQ-approved electronic recordkeeping is used.

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.