638 Bridge CITY QF'COPPEL:L WAT�12 UTI.LITIES
CiISTOMER SERVICE�NSPECT1014
Residentiai � Commercial ❑ TNRCC ID#U57004D
I f✓��� /f f""r� ,,'���� upa���pecfiun af the ri��te waier distii6atiou facili'
� nzs lacatei xt
�3��r'�'�y�'''� ,wkuich is connecied to the City of Coppell Water System,do hereby certify
that,to tfie best of my knaw3edge:
� Non- N/A
Compliance Compliance
(1) No duect connectian between Yhc publia drinking wat�r supply and a potentiaI �(/ ' Q p
source of cantamiaati.on exisrs. Pntentia� sourc�s of contarrtination are isolated ' '
fram rhe public water system by an air gag or an apgrogriate backftow greventian
assemb3y in accordance with Couunission regvlacions.
{2} Na cross-conneciian batween the gu�lic drinkmg u�atex supg�y aud a privaie water i� p p
systern exists,�1�lIsere an actual air gap is not maintained he�en the public water
snpply and grivate water soppIy, an approved reduceti pressure-znne h�eckfl�w �
, preventian asscmbly is properly installed and a s�rvice agreement exist5 for
ann�al inspectioriand tes�ting by a certified bacic#law prevention device tester.
(3) 2�Io cflnneetian exists �Which would aIlow the rctum af water used for condensing �% p �
x cooliag nr�dustrial grocesses back tu the publie water supply,
(4) Na pipe arpi�x fitting vsrhich contains more than 8.0%�ead exists in private water �� p ❑
distributian facilities installed on or after.duIy I,1�8$. .
(5) No sfllder or fiux w3�ich confains mare thau U.2°/a lead exzsEs in pri�ate water � , .p• • .. p
dish�'bution facilities installed nn or after 7uly 1,I938.
.. •
Water service shall nat be grovided oz restored to the private water disttibutinn faciliues until the above eonditions are detecmined to be
iu conzp2iance.
I certify that tt�e fallowing tnaterials will be used ia the installatian of the pnivate�vater dism'bution facilities Idcated at
and that ihe inspector wii.i validaie compliance dur�ng the inspecrion grocess;
Service lines Lead O Coppec t7 pV'� • ❑ p�r ,�("
Solder Lead q I.ead�ree � Solvent Weld O Othcr �❑
a°
I recognize that this documeut shail becoma a pennanent record of the afarementianed Pnbfic Water Systcm and that I am Iegally
responsib for the validaty of t�se information I]aavc providad. �
,� � "'
Signature af Lice d Plumber Registratiaa�Num.beF
�.�P� � ._
Typa of Re,gistrarion Bate
1 recogzzize that•this dncument shalI become a pecmanent recozd af tlte aforemenrioned Publi�Water System aAd that T am IegalIy
respon ' le for the validity af the infarmation pravi$ed.
���
Signature of I pector Re�istration Nvxnber
�� � �� �� �'1 � ��
Type ofRe�is4-ation Datc
YJhi¢-Customcts Cupy Yaliow-Cit�s Capy Piok•[atpcbofs Capy