120 Rosebriar Resk�drnti�l � Camrnercf9l � TNRCC 1q�tOS70040
J �� �Tl� ����" ,upot� iaspection of t�e�nvate wata dis�ribution faeilidea located a�
j�G l�G�.L ' 2f4,�� .which is counectcd to the City af Coppell W�tsr Systcrr� c3o hcrcby certity
ci�et,to thc best of my k�wied��:
ln Nan• N/A
Co �ance Compliaace
(t) ldo dircct co�ncdion betwcta the public dr�i�tki�g water su�ly ae►� a patentia�l Q p
source of cantamir�ation txists. Poteritie3 saurc�s of contamination are isolated
frorn the pubtic wateE�y�trm b3► sn.�ir gap ar u� ap�opriste backflow preventioa
asacmb�tu►sctard�nct with Commis�siot��egut�tic�s.
(2) No cross-can��c�ian bttwccn tht pubtic dfinkiu�w�ter wpply and a privsle waoer �� p p
aystem exats_ Wherz�n utwl au gs�i�aot mt{mmined b�tween the publit wetar
supply and priv�t� wittr suppJy, Ai1 ��p[Ovtd redutCd preSSllnG-zo�e beckflav►�
pr�vaits�� assembly i: praperiy ir�stzlled and � �en+ice agreanent cxists fvr
annual ivaspcction and teating by s cerrificd backilow prevcation device kstrr,
(3) No conaeckion exiats wls�ch woul�a[taw tha red�rn of wstcr tiscd tor carudcasi�� � O O
coofi�or ind�strial pto�csses back to the public wsteT supply.
{4} No pipc or pipe fi�ing wbich conrains Morc th�a 8.0°61e�d exists i�private water � p ❑
distributi�fa�iliti,ees ins�lted on ar after IU�y 1� 1988.
(5) No soldtr c►r fltuc which conisins mare th�n 4.3% lcad exists in pnvate watrc Q p
distri�tion ficiliti�s ia�talkd o�or sftu July 1, !9$8.
Water scrvue sh�ll nat be pravidtd or res�ored to t�+e priv�te water distribution f�cil�ties uacif the abo�e caadidoas ue dctcrmir�ed to i�
ia car�liss�cc. -
I c.crtify that the followiug msteriels witl be wed in the i�atallatiaa of dse privat�wetcr dia�tibuti+�n fae;titizs bcated �t
� �� K-���t�f2�A IZ �� �nd lhet the inapectot will v'lidate compliwce dwiag the insptct;an ptoces
�ee*�•�• ��, Lead 17 Copper P�C � th6er D
� Lead C� Ltad Free Solvent Wald O Other O
1 re�agniu rhvt ihis documeRt sha11 bccamc a pecmtnent recotd of the�foremtn�iancd Publit W4ter Systtm and t'hst T Ym kgally
respe for tJu vZlidity of � fcrrmation t hsve prov;ded.
.�` � � _
Sign re of'Lxcen�ed P mber , Regisaac;an Namber
� Q �'�`�- Ltit1LC��'1L�S ��? /
"I'�rpc of Registratian Date
1 reta�ize that lhis document sha11 become e p+�nsnent�tcor+d of the aforementior�e�Pubtic Water Systern aad th�t (�m kgally
rtspansiblt for the v3Zidity of the ulfonn�tion prvv;dcd,
Signature of Inspectrnr Rcgistretioe Nurnbcr