638 Bridge (2)CITY QF'COPPEL:L WAT 12 UTI.LITIES
CiISTOMER SERVICE NSPECT1014
Residentiai Commercial TNRCC ID#U57004D
I f /f f""r ,,' upa pecfiun af the ri te waier distii6atiou facili'nzs lacatei xt
3 r''y''' wkuich is connecied to the City of Coppell Water System,do hereby certify
that,to tfie best of my knaw3edge:
Non- N/A
Compliance Compliance1) No duect connectian between Yhc publia drinking wat r supply and a potentiaI Q psourceofcantamiaati.on exisrs. Pntentia sourc s of contarrtination are isolated
fram rhe public water system by an air gag or an apgrogriate backftow greventian
assemb3y in accordance with Couunission regvlacions.
2} Na cross-conneciian batween the gu lic drinkmg uatex supg y aud a privaie water i p psysternexists,1lIsere an actual air gap is not maintained he en the public water
snpply and grivate water soppIy, an approved reduceti pressure-znne h eckfl w
preventian asscmbly is properly installed and a s rvice agreement exist5 for
ann al inspectioriand testing by a certified bacic#law prevention device tester.
3) 2 Io cflnneetian exists Which would aIlow the rctum afwater used for condensing pxcooliagnrdustrialgrocessesbacktuthepubliewatersupply,
4) Na pipe arpi x fitting vsrhich contains more than 8.0%ead exists in private water pdistributianfacilitiesinstalledonorafter.duIy I,1 8$.
5) No sfllder or fiux w3 ich confains mare thau U.2°/a lead exzsEs in pri ate water p• • .. pdish'bution facilities installed nn or after 7uly 1,I938.
Water service shall nat be grovided oz restored to the private water disttibutinn faciliues until the above eonditions are detecmined to beiuconzp2iance.
I certify that tt e fallowing tnaterials will be used ia the installatian of the pnivate vater dism'bution facilities Idcated at
and that ihe inspector wii.i validaie compliance dur ng the inspecrion grocess;
Service lines Lead O Coppec t7 pV' p r ,("Solder Lead q I.ead ree Solvent Weld O Othcr a°
I recognize that this documeut shail becoma a pennanent record of the afarementianed Pnbfic Water Systcm and that I am IegallyresponsibforthevalidatyoftseinformationI]aavc providad.
Signature af Lice d Plumber Registratiaa Num.beFP
Typa ofRe,gistrarion Bate
1 recogzzize that•this dncument shalI become a pecmanent recozd af tlte aforemenrioned Publi Water System aAd that T am IegalIyrespon ' le for the validity afthe infarmation pravi$ed.
Signature ofI pector Re istration Nvxnber
1 Type ofRe is4-ation Datc
YJhi¢-Customcts Cupy Yaliow-Cit s Capy Piok•[atpcbofs Capy