Backflow Prevention Assembly Test & Maintenance Report

The following form must be completed for each assembly tested. A signed and dated form must be submitted to the public water supplier for recordkeeping purposes.

Please print, fill out and send to LMUD by e-mail ( or drop it off at our office:
1097 Lohmans Crossing, Lakeway, TX 78734

Please call us if you have any questions: (512) 261-6222 ext. 110

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