627 WesthavenITY QF COPYELL WATER UTILIT ES
C JSTQMER SERVIC NSPECTIOIti
Residential ,`' Cummerciat TNRCC ID#057D04Dr
I f ^''` u n ins ectinn of th rivate wate
7
F P F r distnbution facilmss located at
4'de which is cotmecied ta the City of Coppell Watcr System, do hercby certify
that,ro the best ofmy knawledge:
PTon- N/A
Compliance Compliance
i} 3Vo direct con aectiaz between the puhlic drinfcing water supply and a potential p
source of contamination exists. Potential sonrces of cantumination are isolated
from the public water system by an air gap br an appropriate backflow prevention
assembly in accordance with Commission regulations.
2) No cruss-connection betw en the pubiic drin}eing water supply and a private water IY D Osystemexists. 1Vhere an actual air gap is noi rnaintained between the public water
suppIy und private water supply, an apprnved rednced pressurc-aons backflot
preventiou assembly is prnperly installed and a service agreement exists for
annual inspection and tesfing by a certifed backflnw prevention device tester.
3) IVo connecrian exists which would allow lhe retum of water used for condensin
aoling or industria}processes back tv the public water supply.
4) Na pipe or pipe fitting which contains mure than 8.0% lsad exisis in private water p
distri urian facilities instaAed on or after,Tuly I, 1988.
5) No solder or fiux which contains mare than 0.2°la lead exists in private water t/ p • p
distribution facilities installed on ar after July 1, 1988.
Y•'
Water service shaIl nflt be provided or rest red to the private water distribution facilities uatil the above eonditi.ous are detezmi ed tq beincoinpliance.
I certify that the fallowing materials will be used in the installation af the.private water distriburion facilicies ldcated at
and that tha inspector will validate compliance t uring the inspection process:
Servace lines Lead Cogper PVC CJ Qttier [Solder Lead q X.ead Free Solvent W ld O Other
I recognize that this document shaIl6ecome a pernianent re ord of khe aforementianed Puhlic Water System and that I am legallyresponsibforthevalidityoftheinformutionIhaveprovided.
7" "'
Signature af Lice l Plumber Re isirati n Number
Type of R.egistrafion D te
I recognize that this document shall become a pezznanent record ofthe aforementioned Public Water System and that I am legallyrespo ' le far t ae validity af the infomcation provided.
C
Signature ofI ector Re is tio Number
6 Typs af Registration Date
Whiu•Custamer'c Cupy YeClow-Cilys Copy Pidc.Insponofs Copy