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

No. The report has no notary block. The licensed tester signs it and affirms that the information is true and correct.

How do I submit the backflow test report?

Submit it online using the form’s Submit button, print and mail it to the Public Works Department address shown, or use one of the email addresses listed on the form.

What information does the report request?

It asks for property and assembly details, test results, repair information, gauge details, the reason for testing, and the licensed tester’s information.

Who completes this report?

The form includes a licensed tester’s name, signature, company, and license information, and requires the tester to affirm that the information is true and correct.

North Richland Hills, TX · Tarrant County

No notary required

Backflow Prevention Assembly Test and Maintenance Report

Licensed backflow assembly testers use this report to record inspection results, repairs, gauge details, and property information for submission to North Richland Hills.

What this form is

This report records the condition and test results of a backflow prevention assembly, along with property, assembly, tester, and gauge information. A licensed tester completes it after testing or maintaining an assembly, including details about repairs and any test after repair. The form also asks why the test was performed and whether the assembly was installed according to manufacturer recommendations or local codes.

Who needs it

A licensed tester who tests or maintains a backflow prevention assembly for a property in North Richland Hills completes and submits this report.

How to submit it

Submit online using the form’s Submit button, or print and mail it to Tuan Ngo, Regulatory Compliance, City of North Richland Hills Public Works Department, 7200 A Dick Fisher Dr., South, North Richland Hills, TX 76180. The form also lists email submission to [email protected], [email protected], and [email protected].

About notarization

This report has no notary block; the licensed tester signs it and records test dates while affirming that the information is true and correct.

How to submit this form

1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report.
2
Complete The Form
Enter the property, assembly, test, gauge, repair, and licensed tester information requested.
3
Review The Report
Check the test results and required fields, then have the licensed tester sign the report.
4
Submit To The City
Submit online using the form’s Submit button, or print and mail or email it using the details listed on the form.

Frequently asked questions

Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?: No. The report has no notary block. The licensed tester signs it and affirms that the information is true and correct.
How do I submit the backflow test report?: Submit it online using the form’s Submit button, print and mail it to the Public Works Department address shown, or use one of the email addresses listed on the form.
What information does the report request?: It asks for property and assembly details, test results, repair information, gauge details, the reason for testing, and the licensed tester’s information.
Who completes this report?: The form includes a licensed tester’s name, signature, company, and license information, and requires the tester to affirm that the information is true and correct.

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.