Davenport, WA · Lincoln County
Backflow Prevention Test Report
This report records backflow prevention assembly test results for the tester submitting the completed report to the City of Davenport.
What this form is
Use this report to provide the City of Davenport with test results for a backflow prevention assembly. The form includes fields for the account, service address, device and hazard, test measurements, repairs, comments, and test date and time. The tester certifies the report and provides a signature and tester number; a test due field is also included.
Who needs it
A tester reporting backflow prevention assembly test results to the City of Davenport uses this report.
How to submit it
Send the completed report to City of Davenport, Box 26, Davenport, WA 99122, or fax it to 509-725-4300, as shown on the form.
About notarization
This document is signed without a notary; the tester certifies, signs, and dates the report, and no notarized attachment or sworn step is listed.
How to submit this form
- 1
Download the Report
Download the Backflow Prevention Test Report.
- 2
Complete the Report
Enter the assembly, account, service address, test results, repair details, comments, and test date and time.
- 3
Sign and Certify
The tester certifies the report and provides a signature and tester number.
- 4
Submit to the City
Send the report to City of Davenport, Box 26, Davenport, WA 99122, or fax it to 509-725-4300.
Frequently asked questions
- What does the Backflow Prevention Test Report record?
- It records details about the assembly, service address, test measurements, repairs, comments, and the test date and time. The tester certifies the report.
- Who completes the backflow test report?
- The tester reporting a backflow prevention assembly test completes the report, including the test results, tester signature, and tester number.
- How do I submit the Backflow Prevention Test Report?
- Send the completed report to City of Davenport, Box 26, Davenport, WA 99122, or fax it to 509-725-4300, as listed on the form.
- Do I need a notary for the Backflow Prevention Test Report?
- No. The tester certifies, signs, and dates the report; the document lists no notarized attachment or sworn step.