Snyder, TX · Scurry County
Backflow Prevention Assembly Test and Maintenance Report
Licensed testers complete this report on-site to document backflow prevention assembly testing and provide the signed original to the public water supplier.
What this form is
This report records the results of testing and maintaining a backflow prevention assembly. A licensed tester completes it on-site while testing is underway, records assembly, test, gauge, and tester details, and signs and dates it. The instructions say a signed and dated original must be provided to the public water supplier for recordkeeping, and all report pages must be submitted.
Who needs it
A licensed tester who tests a backflow prevention assembly completes the report and provides it to the public water supplier.
How to submit it
Provide the signed and dated hardcopy original to the public water supplier for recordkeeping. Submit all pages of the report to the water system.
About notarization
The licensed tester signs and dates this report without a notary; the document describes no notarized or sworn attachment.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report.
- 2
Complete It On-Site
The licensed tester completes the report while testing is underway, by hand or electronically.
- 3
Record Test Details
Enter assembly, test, gauge, and tester information; include all report pages.
- 4
Sign And Submit
The licensed tester signs and dates the report. Provide the hardcopy original and all pages to the public water supplier.
Frequently asked questions
- What does the Backflow Prevention Assembly Test and Maintenance Report document?
- It records test and maintenance results for a backflow prevention assembly, including assembly details, test readings, gauge information, and licensed tester information.
- Who completes this report?
- The licensed tester who performs the work completes the report on-site while testing is occurring. Follow-up testing by a different tester must be documented on a separate form.
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The licensed tester signs and dates the report without a notary; the document describes no notarized or sworn attachment.
- How do I submit the Backflow Prevention Assembly Test and Maintenance Report?
- Provide the signed and dated hardcopy original to the public water supplier for recordkeeping. Submit all pages of the report to the water system.
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.