Backflow Test Report - City of Seguin - seguintexas 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Customer Information' section. Enter the service address, occupant/business name, mailing address, contact name, and contact number.
3. In the 'Device Information' section, indicate whether the assembly is new, existing, or a replacement. Select the type of assembly from the provided options and fill in the manufacturer, model, size, and serial number.
4. Complete the 'Initial Test' section by documenting results for each check valve and differential pressure relief valve. Ensure you record any leaks or if they held tight at specified pressures.
5. If repairs were made, document them in the 'Repairs & Materials Used' section and perform a test after repairs. Record results similarly as before.
6. Fill out the 'Tester Information' section with your name, license number, business details, and test gauge information. Don't forget to sign and date at the end.

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