Water Department
1202 Southmore Ave
Pasadena, Texas 77502
2021
Backflow Tester Registration Application
An applicant for registration shall:
1. Provide proof of current Texas Commission of Environmental Quality (TCEQ) Backflow Tester
certification in accordance with all applicable regulations.
2. Provide proof of testing equipment in accordance with current TCEQ regulations and calibrated to
properly test. (Please provide a copy of your current gauge calibration form.)
3. Complete this form and pay a non-refundable registration fee of $75 to the City of Pasadena. After the
initial fee is paid, registration is due annually on or before January 31st. Payment can be made to “City
of Pasadena” with a money order or by credit/debit card (if paying with credit/debit card, a $3
processing fee will apply) at 1202 Southmore Ave. If mailing a money order, mail to City of Pasadena,
PO Box 1337, Pasadena, TX 77501. You can also download the form on our website, scan and email to
wbcs@pasadenatx.gov with subject “Backflow Tester Registration”. Once you email your application
and required proof, you can call in your payment to 713.475.5566; the $3 processing fee applies.
Please Print
Company Name (if applicable): ___________________________________________________________
Tester’s Name: _________________________________
BPAT No: _____________________
Address: __________________________________________________________
City: ___________________________________ State: _________________ Zip Code: ______________
Mobile #: __________________________ Business Phone #: __________________________
Email: _________________________________________________________________
Gauge Information:
Brand:______________________________ Model: _______________________________
Serial No. _______________________ Calibration Date:___________________________
Signature: ____________________________________________________
With this signature all given information is true and matches attached proof for TCEQ license and equipment.
Expiration Date: 12/31/2021
For Office Use Only: BFIREG (Cash Receipts Code)
Date Received: ____/____ /_______ Receipt#:____________________ CSR Initials:_______ Water Distribution Initials:________
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