2013_1030 . , . , � �.�..fl.:y �-� �, „� . .�. ..-. ,
� '"' � CITY pF COPPELL WATER UTILITIES
° CiJSTOMER SE�tVICE IN$�ECTIOl�
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R�sidential � k` Commercial � TNRCC ID#057Q040
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I � f,,�Q�`�"T'• ; � &�+�'"� "�` �� ,upon inspection of the private water distribution facilitics located at
�i ,���.� . �q�!/� �~r,,/ �'�"'. , which is conuected to the City of Coppell Water System, do hereby certify
that,to tiie best of my knowledge;
In Non- N/A
' Com li Compliance
(1) No direct connection between the public d'rinking;water supply and a potential � . O ❑
source of contaminarion exists. Fotential'sources'of contaminla6on are isolated
._,,� � � � : ;� � , .
frotn the public water systetn by an sir gap or an appropnate backflow preveation " '" `
assembly in accordance with Commission regulations. . �
(2) No cross-connection between the public drinking water supply and a private water � p ❑
system.exists. Where an actual sir gap is not maintained'between the public water' ;�
supply and private water supgly, an approved reduced pre�sure-zone baekflow
prevention assembly is properly installed and a service agreement exists for �I
'aanual inspecrion and xesting by a certified backflow prevention device tester.
`(3) No connec�ion exists which would allow the return of water used for condensing p' ❑ ❑
' cooling ar industrial processes back to the public water supply. ,.:�
(4) No pipe or pipe fitting which contains more than 8.0%le�d exists in private water � ❑ p
distriburion facilities install�d on or after 7uly 1, 198$.
(5) No solder or flux which contains more than 0.2°7o Tead exists in private water , � p ❑ ;,
distriburion facilities installed on or after July l, 1988.
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Water service shall not be provided of restored to the private-water distriburion facilities until the above conditions are determined to be
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in compliance. ;.
I certify that the following materi�tiS will be us�d ia the installarion of the private water dis�ibution facilities located at
� �� �•�'Y�'l�l 1 r� �1 and that the inspector will validate compliance during the inspecrion process:
Service lines Lead ❑ Copper ❑ PVC ❑ Other J�
ol e Lead ❑ Lead Free � Solveat Weld ❑ Other E7
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I recognize tt►at this document shallbecome a permanent reco'rd of the aforementioned Public Water System and that I amlegally
responsibl for the validiry of the informaHon I have provided.
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Sign o�'Licensed Plumber Regis�atiott Number
�/J�a1` �'—�"r�' ���� �-�'/�' lrG3 ��. �L'? -;•/,,,,�
Type of RegisGrarion Date
I recognize that this document shall become a permanent record of the a€orementioned Public Water System and tttat I am legally
responsible for the validiry of the information provided.
Signature of Inspector `� ` Registration Number'
Type of Registration Date
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