Portland, TX · San Patricio County
Backflow Prevention Assembly Test and Maintenance Report
Licensed testers complete this report for each backflow prevention assembly tested and submit the signed, dated original to the public water supplier.
What this form is
The report records the assembly type, location, test results, maintenance or repairs, and licensed tester information. A completed, signed, and dated original must be submitted to the public water supplier for recordkeeping for each assembly tested.
Who needs it
A licensed tester completes and submits this report after testing a backflow prevention assembly for the public water supplier.
How to submit it
Submit the signed and dated original to the public water supplier for recordkeeping. The form does not provide a specific submission address or contact details.
About notarization
No notary is required; the licensed tester signs and dates the report, and it lists no notarized attachment or sworn step.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report.
- 2
Complete The Test Details
Record the assembly information, test results, repairs or materials used, and licensed tester details.
- 3
Sign And Date The Report
The licensed tester signs and dates the completed report.
- 4
Submit The Original
Submit the signed and dated original to the public water supplier for recordkeeping.
Frequently asked questions
- What is the Backflow Prevention Assembly Test and Maintenance Report?
- It records test results, maintenance or repairs, and tester details for a backflow prevention assembly. The form must be completed for each assembly tested.
- Who completes this report?
- A licensed tester records the assembly details and test results, then certifies the report by signing and dating it.
- How do I submit the report?
- Submit the signed and dated original to the public water supplier for recordkeeping. The form does not give a specific address or contact details.
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The licensed tester signs and dates the report; it does not list a notarized attachment or sworn step.
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.