River Oaks, TX · Tarrant 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, manufacturer, test results, repairs, gauge details, and licensed tester information. It must be completed for each assembly tested, and the signed, dated original must be submitted to the public water supplier for recordkeeping. The form also asks about the reason for testing and whether the assembly is installed according to manufacturer recommendations or local codes.
Who needs it
A licensed tester completes and submits this report for each backflow prevention assembly tested for a property served by the public water supplier.
How to submit it
Submit the signed, dated original to the public water supplier at 4900 River Oaks Blvd., River Oaks, TX 76114.
About notarization
This report is signed and dated without a notary; it contains no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report PDF.
- 2
Complete The Test Details
Complete a report for each assembly tested, including assembly information, test results, repairs, gauge details, and tester information.
- 3
Sign And Date The Report
The tester signs and dates the report; no notary is required.
- 4
Submit The Original
Submit the signed, dated original to the public water supplier at 4900 River Oaks Blvd., River Oaks, TX 76114.
Frequently asked questions
- What is the Backflow Prevention Assembly Test and Maintenance Report?
- It records test and maintenance details for a backflow prevention assembly. The report must be completed for each assembly tested and submitted to the public water supplier.
- Who completes this report?
- A licensed tester completes the report, including assembly details, test results, any repairs, gauge information, and tester credentials.
- Do I need a notary for the Backflow Prevention Assembly Test and Maintenance Report?
- No. The report is signed and dated without a notary. It contains no notarized or sworn attachment.
- How do I submit the Backflow Prevention Assembly Test and Maintenance Report?
- Submit the signed, dated original to the public water supplier at 4900 River Oaks Blvd., River Oaks, TX 76114.