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Application for Backflow Assembly Testing Within the City of Lewiston Water District

  1. (*Mandatory every two years)
  2. (*Mandatory annually)
  3. NOTE: The City of Lewiston has your permission to distribute as well as post your company, employees, and telephone number on the City's web page, available to the general public. Please check one:*
  4. **NOTE: The City of Lewiston requires both a backflow assembly test report be submitted to the Water Division within fifteen (15) business days of a test, and a "TAG" containing the tester's name and date of satisfactory test be attached to the assembly. Any backflow prevention assembly left in a failed (non-passing) condition, creating a potential threat to the potable water supply, must be reported to the Water Division within two (2) business days. Registered testers can submit reports online at Only new installation test reports will be accepted via email, fax, or US mail.
  5. Do you plan to test backflow assemblies for a Fire Protection company?*
  6. If you answered "Yes" to the above question, please complete this section. If you answered "No", this section does not apply. 

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  8. This field is not part of the form submission.