White Settlement, TX · Tarrant County
Backflow Prevention Assembly Test Report
This report records backflow prevention assembly test results and is completed by the tester for the property owner and Building Inspections.
What this form is
Use this report to document a backflow prevention assembly test, including whether the assembly is existing, new, or replaced and the test results. It asks for property owner and assembly details, readings and results for the applicable assembly tests, repairs or parts comments, and the tester’s signature, certification number, name, and gauge number. The document does not state when the city requires the report.
Who needs it
A backflow assembly tester completes the report with property, assembly, test, and certification details for the property owner and Building Inspections.
How to submit it
The form names Building Inspections at 214 Meadow Park Dr., White Settlement, TX 76108. It also lists phone 817-246-4971 and fax 817-246-8761.
About notarization
This report has no notary block; the tester signs it and provides a certification number, with no sworn or notarized attachment listed.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test Report PDF.
- 2
Complete The Test Details
Enter the property and assembly information, test results, and any repairs or parts comments.
- 3
Add Tester Information
Provide the tester’s signature, certification number, printed name, gauge number, and company details.
- 4
Send To Building Inspections
The form lists Building Inspections at 214 Meadow Park Dr., White Settlement, TX 76108, and fax 817-246-8761.
Frequently asked questions
- What does the Backflow Prevention Assembly Test Report record?
- It records property and assembly details, test results, repairs or parts comments, and the tester’s signature and certification information.
- Who completes the Backflow Prevention Assembly Test Report?
- The form includes fields for a tester’s signature, printed name, certification number, gauge number, and company and phone details.
- Do I need a notary for the Backflow Prevention Assembly Test Report?
- No. The report has no notary block; the tester signs it and provides a certification number. No sworn or notarized attachment is listed.
- How do I submit the Backflow Prevention Assembly Test Report?
- The form names Building Inspections at 214 Meadow Park Dr., White Settlement, TX 76108, and lists fax 817-246-8761.
Need something notarized?
This Backflow Prevention Assembly Test Report doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.