2016_0617 CITX OR'CC�PP�I.L WAI'LR U�'T'��S'
CUSTflMER SERYICE�SFEC71014
Rcsid lial �' . CommcrcCal 0 TriR+CC IIDi#G57004U
I G�� n n ias eatian af th� rfvau wa[sr distn'b�Yic�u facilities lacat+�d at •
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" 7 n �o� wlsiah is conaxted ta t�aa City of Coppaal't�lat�r Sy3tarn,da+heseby�rtify
` tLat,t�ihe best af aay Jmowkd�e.
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�ompIianc� CcErtpliancc
(L} Na diree��coun�doa tictw:cGn tbc pct�r�ia draakiag water supply and a pat�at3at �'' ' C1 C]
s�urce of�'stamtasti�t�e�rists. Pat+�ttial snurc�s at can " tinn s�r�'isalaced • �
fiam thc publie watcr sysi�m by aa a�x ga�a-ar aa approp�iate backflcw pxG�+eation
assembly a�accordanc�wit�t C�musission regulations.
(2) No crQs�-conncctian bacwcezt tbt puUlic drink�g'watcr supply and a;pzava�c v�attet i�'' D C�
s}?stem'ezfs�s.�'Wh�re aa a�t�l aar gap is aot mai�tiaiocd beiwcett thc publ�c watcr .
suppl'y and.ptivate water svpglY, an sPPrcrved �d�ccci pressnrc•zoue�ackflow
, pr�venti� asstx�ly is properly insstal[td and a servicc agr�m�iit �tiiists for
annual insptctiaaand tcsting by'a ccrtifitd backf�ow prcven�on devicc tester:
(3) Na con�ecAon exists whioh wauld allow khe retum af water used F'or condeasing �,✓ l� C1
, caairng m,�ndust�3a�proGe�ses ba�3c tn We public water'suppiy,
(4� Na pipc or pipe�ing urhich cantaias marc tt�a�8,0`/o tead�Ia p�ivate watcr �• D ❑
�aan fac�.ities insxallcd o�ar aftez July I,14�8.
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(S} No soldcr or flnx vv3�icli r.�ntains tttore than 4.2"fa lead cxists in�rivatc watcr �],/ ' ,p , CI
distti'bution facilitirs inst�lled on ar aftcr 7uly t,I9S8.
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Watar s�rvice s�aail aotbs prvvid�s3 ar restored fn the private water distn'�x�sticn fac�ities ua��e abava eanditi�aas ara dctes•nuacd to be
in r.ampliatscc. .
I c�rtify that tbc fallowing maaterials tvitl be used in the installatton af thc,privatr water distn'butian fecilitus idcated�t
��e7- �n.�i2���� and t2sat ihc iaspector+wi11 validute compl�ucc dsniq�t�a�rzspt�tioa groeass:
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Setvice la'rres Lead I7 Coppec ❑ PVC ' i7 4tfitr �
Sotdcr T.ead L� �.c�ati�r�o ,°6�' Salvent W��d C] Cltfaer ❑
I rr.caguiz�tharthis decumr.at shail bcccme a pr,r�a�ni recard of the aforcmcntioncd Pc�blic V,�at�S3rstem and tbat I am lcgally
r�tra�'ta�far thevalidity ofihe in�armation F have piovidad.
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Si � o�'�.iceri�d Ptsuiwer Registtatfon�Tumber
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Z rcccgnizt that•this document shaU becomc a permaacnt racaxd of thc afarcmentiaa�d Publit Waier Systicm ar�d tbat I am kgalty
respo , k focthe vaiidity aftl�,e infq tion provided.
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