2016_1017 Texas Commission on Environmental Quality
i
Customer Service Ins ection Certificate
Name of PWS: Cit of co ell
PWS ID#: 0570040 �
Location of Service: j
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eason for Inspection: New construction , p �
............................................................................. ❑
Existing service where contaminant hazards are suspected...,........
Major renovation or expansion of distribution facilities....................�'
( t ..�f\'e�►����Q , upon inspection of the private water distribution facilities
connected to the aforemenfioned public water supply do hereby certify that, to the best of my
knowledge:
Com liance Non-Com liance I
��� No direct connection between the public drinking water supply
� and a potential source of contamination exists. Potential
sources of contamination are isolated from the public water
system by an air gap or an appropriate backflow prevention
assembly in accordance with Commission regulations. !
, (2) No cross-connection between the public drinking water supply and
❑ a private water system exists, Where an actual air gap is not
maintained between the public water supply and a private water
supply, an approved reduced pressure principle backflow �
prevention assembly is properly installed and a service agreement i
exists for annual inspection and testing by a certified backflow �
prevention assembly tester.
(3) No connection exists which would allow the return of water used
❑ for condensing, cooling or indusfrial processes back fo fhe pubfic
water supply. I
(4) No pipe or pipe fitting which contains more than 8.0% lead exists
❑ in private water distribution facilities installed on or after July 1,
1988 and prior to January 4,2014.
(�� Plumbing installed after January 4, 2014 bears the expected
❑ labeling indicating s0.25% lead content. If not properly labeled,
please provide written comment,
(6) No solder or flux which contains more than 0.2% lead exists in
❑ private water distribution facilities installed on or after July
1, 1988.
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I further certify that the following,materials were used fn the Installation of the private water dfstribution facilities:
Service lines; Lead ❑ Copper PVC ❑ �Other ❑
Sofder; Lead ❑ Lead Free Solvent Wefd ❑ Ofher ❑
I recognize that this document shall become a perm nent record of the aforementioned Public Water System and
that I am le all res onsible for the validit of the information I have rovided.
Remarks:
Signature of Ins ector: Re istration Number: p
Title: T e of Registration: � L �-
Date: Q�'��
White—City Yellow—Customer Pink-Inspector