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146 Washington 6f26J2015 �•1P9 CITY O�C9PPELL i�'ATF.R C�T`1LiTIES Cl'STC�MER S�RVIL'E iNSPEC3'IA:ti Residrntiat ''�j Commercial 0 T;"��tCC IU#4S7QOA0 1- ��s���.����"�..__..��_l.`-�..,..��.—.__�<u�n usspe��ior�af the;?nti�te a=atcr dssanbution facYlincs ia�at�c4�>. __��.���_���..C�.1hl��e1__.��v__,_..•which is ccranc4ted to the Cirv c,#�CappeS!�'ater S��stem,da hesebe crrt�f} that,to tfic�xst of rrAy knowledge�. In :tion- ti A i.ompldan�e Cvmpliance {�) ?*�� �irett conre�tian bct+seen the puhl�c drinking w�ter su�spty arrc3 a �-,osentra� � [3 L� sourre c�f:or.raminadpn exisu. Potenfiai saturces of ec�ntamina�ifln are is�latec! from tl�e pub4sc w�ater sys�em by ast afs gap or an appropnate backfI�u prevent6ar assembiy u:a�cordancc��ith Cammissian regu}ations. (2) 'v'a erass-cannect�ora bchveen thc public�inksng wacer suppiy and a privatz u�ater �id � G systeaz exists. �L'}aerc an actual au gap is nnt maintained bctween the pubdic water supplv ancf pnvacc a=aser supply, an approved reduecd prt�ure-zonc backfl�K preventian assrstFbl}• is prerperly insstalled and a sen�ice agrecment exists f�r annual uss.pettian and tcsting by a c�ified backtlow prcvrntecrn de`°iee tes#er. (3) �o connection exuu w�hich would altow the recum of vvatcr used for c�r�densin� B L7 �7 cooIing or utdustnat processts back to the pubtic water sup�afy, f�4) !ro p�pe or pspe fittang v�•hicb contains rnz�rr than 8.�?°Ig Iead cxtsts izz grivart u�a3er f�. C7 C7 dystributson faeiiitres znstalltd on or after Iuf} 1, i9�8. (�j Na solder os tlnx w�}�ic� cnnt,�inc mare tfian �2°Fn ieac3 exists u. pri+rate .�-ater �I II � distFibution fxc�laties iisstallcd an or aficx lu7y 1, ;988. Vi'�trr sen'see shsH nos be pro�nded or restoxed io thc jarirare wattr dastributicsn faciliti¢s;antil tht abo��c eonciidons are detemuned to be in compliancc. I certify Lhat the followtr3g macerials v��il!be nsccd in tht insta3lataQn aFthe�ri��ate��aser dis�ibutioQ factli�ies lofated at_�._._______.__ �'t�_�_� t�.�n) � _��c!z}kac the inspectc�r+����1 vaJiciate c€7rripliance durvsg thc in�pcetion proe�ss �*vic le ines Lead L7 Coppes v P�`G 0 Gthtr �1 r'��- �o1d�r Lcad E� Lead�r�ee '� So?vent l��els� � t��cc [7 t rt�ra�ize th�t this drxessr.ent sha3P�A���sc a petn��nrrst rec�rd af;3;r af'crezaer.ti�nc�'I'u�isc L1'ater Systrm aad that 1 atn Ir�al�y rrs�sib3c f"or thc wal�di�z�c,f�#ac inlarmatinn I �vr p.rrr�i�ed_ !� F;; ��.,.�_.�� ��_.� ___����.�w___..�_____----____.____._ St,g� na�rc of Licensed Plumber �eerscraEaE7��u�ri�r __�.-� -- -��-....._ .._�_.__ ._..._._._____.__ � �U �t 5�` ___. _.. _____ _.---,_ ._�_____.____�____� .___ .___ Ty{+er��Re��s¢at r� [?�anc 3 rtc�gnize zhat this d�w»ettt shali becoFne a perrrzanent recard�,f�the aforecrs�nte�ned Put+l�c�'atz;Sy�ssem and dhat 1 am treatly respe�yssibte for the�alitiicy c*f t3te�f�rmatia prati��id c3. 3 � � � 0 1 __�,1�.��: .� _�_ .___ _____- _ _�_�-�3`� __ __._._ __ __...._._. _ ______._.__ Signa rt of tnspcct�r Re�i,�rati�n'�t.r*�t�,e �"- -- � r7 � �-# �'t S --.�-.-- �----_ _ _.---_ _.__._____ ._.____.__ ___ ._�� _ __ _.� _ _.,______.____.__��___ . _. ... __. Type of Reg�n Date W'4+1t-CuunmedcC.�7 Fat3aW.f::ors�sCc�a Pmk-;mspee§er!aCIIp4 https://mail.google.com/ lscs/mail-statiG�slk=gm�I.m�n.en.Plx-EHXLv9k.0/m=m_i,t,iUam=PiMavwzf-4MYZ5Bd�kDFy33uQKNCOe &ZA1K9Avi 2f8D-D... 1/1