Manor, TX · Travis County
Backflow Prevention Assembly Test and Maintenance Report
This report records testing and maintenance of a backflow prevention assembly and is completed by the certified tester for each assembly tested.
What this form is
The City of Manor report documents a backflow prevention assembly’s test and maintenance results and certifies its condition at the time of testing. A report must be completed for each assembly tested, and a signed and dated original must be submitted to the public water supplier for recordkeeping. It asks for water supplier and service details, assembly information, test results, repairs, gauge details, remarks, and tester and firm information.
Who needs it
A certified tester completes this report for each backflow prevention assembly tested and submits the signed and dated original.
How to submit it
Return the signed and dated original to the City of Manor Public Works Department at 105 E. Eggleston Street, Manor, Texas 78653; the form lists [email protected].
About notarization
This report is signed and dated without a notary; no notarized attachment or related sworn step is mentioned.
How to submit this form
- 1
Download The Report
Download the Backflow Prevention Assembly Test and Maintenance Report PDF.
- 2
Complete The Report
Complete a report for each assembly tested, including assembly details, test results, and tester and firm information.
- 3
Sign And Date
Have the certified tester sign and date the report.
- 4
Submit The Original
Return the signed and dated original to the City of Manor Public Works Department.
Frequently asked questions
- Who completes the Backflow Report Form?
- A certified tester completes the report for each assembly tested. It records the assembly, test results, any repairs, and tester and firm information.
- How do I submit the Backflow Report Form?
- Submit a signed and dated original to the City of Manor Public Works Department at 105 E. Eggleston Street, Manor, Texas 78653.
- Do I need a notary for the Backflow Report Form?
- No. This report is signed and dated without a notary; the document does not mention a notarized attachment or related 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.