Backflow Prevention Assembly Field Test Report - City of Lake Worth - lakeworth 2026

1. Click ‘Get Form’ to open the Backflow Prevention Assembly Field Test Report in the editor.
2. Begin by entering the 'Test Date' and 'Time' at the top of the form. This information is crucial for record-keeping.
3. Fill in the 'Facility Name', 'Service Address', and 'Customer Account #' fields to identify where the test was conducted.
4. Provide details about the Certified Backflow Test Company, including the technician's name, registration number, and contact information.
5. Indicate whether the operational test passed or failed by checking the appropriate box.
6. Complete the 'Backflow Information' section by selecting the type of use and assembly type, ensuring accurate device classification.
7. Document initial test results, including tightness differential and check valve conditions. Be thorough in noting any leaks or repairs needed.
8. Finally, have the technician print their name and provide a signature to certify that all information is accurate before submitting via email or mail as instructed.

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