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CI'k'Y OT C�pF�LI.,WAT��t UT�x'FIES
C[JS�'OMER SERVIC$�NSPEC 1Tk014 a
Itesidentiai �Y' Commcrcial ❑ TNRCC SD f�05'1D04Q !�
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I - upori inspecfian o�tFle gri��ace water distzihUtion faciIiries located at . � �
���!_`(��� whickz is connected to the City of Coppell Water System,do hereby cez#ify �
: that,to the best of my kvowledge:
. � �
� Tn Non- NtA �°
Compliance Car�Iiance �:
(1) No direct crrnnection betwean th$public drin3dng water supply and a potantial �Jf • � �] !_
source of cpntazninatioa ex�sis. Potential sources of cozztnmination are'iso]ated ' ' '�
fram the ublic water s stem b an air ��
l� Y Y �ap or an appropriate backflow grevention
assemb3y zn ac�ordance with Commission reg�Iatians. . �
{2� 2�o cross-eonnection bEhveen the puialic driuking water supp�y aud a privaie water � p p
system�exists.�l�lhera an acwcil ai�gap is not maintaiaed betweea the�ubIic wateX �
supply und private water suppty, an approved reduced pressure�op� baak�ow � �":
, prevention assambly is progariy installed and a service agreement exis#s for �
annuat inspecfio�and tasting by a oeriifed backflaw pzevettk[on device tester: �
(3) No connecdon exisis w}uch would aIlow the rctnrn of water used foz condensin� � [� �
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� coaI'ing or'sttdnsirxal processes back ta tfta publia�uater supp}y, �:;
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(4) 'No pipe arpipe�itring v�hich corttains mare[hjw 8.0%iead exisfs in private watez � Q [� �
distri6udan facilitles iastalled an ur after.7uIy I,1988. , �
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{5) No solder or flux vr3aich contains more thau 0.2% lead e�cis�s in private water � �p • p �
distn'buaonfaciliHes instalTed an orafter Juiy i,1�88, �
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Water service shall nat be pravidad or restozed to fhe private wat�r disttihution faciliues until the above conditions axe detem�rined zo be �
uz campliauce. �
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I ccrtify that tbe folla��ing tnaterials Evil}he used iu the it�tallation of the priva[e vra#er distn'but�on facilities Ibc�ted at �
_��� ��,��f�, aad that ihe inspector wi1�validtite comp}lauce ciFcrfttg the znspecYion proeess: �
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Sorv�ce lines Lead L] Copper O PVC ' ❑ Otfier � ��
5older Lead q �,ead Free � Solves�t Wel.d ❑ Q��x ❑ `:
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I recognize that this document shallliecvme a pexm cozr3 qf the aforementionad Public Water Systcm and that I atn Iegally �
respans��f the vaIidity of the informati ve provided.
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Sxgtta af�.i�e� mbae Ztegisffaix�u.Num.beF �
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Type ofRegistraTion Date �
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Irecogutze thatthis docarnent shalI become a pennanent record of.the aforementioned Pqbli�Wafex 5yst�m�nd that I am[egally �
respon�j5le for tfie va(idity of the infoanabon pravided. �
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Signa 1 e oS�t�pec[ Registration Nuzn er ;
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Ty�sc of�te�ish�tion Dare .
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