2016_1111 Texas Commission on Environmental Quality
Customer Service Ins ection Certificate
Name of PWS: Cit of Co ell
PWS I D#: 0570040
Location of Service: y y k� � �_
Reason for Inspection: New construction.............................................................................. o-"
Existing service where contaminant hazards are suspected............ ❑
Major renovation or expansion of distribution facilities..................... ❑
� �,�;,,,� N� , upon inspection of the private water distribution facilities
connected to the aforementioned public water supply do hereby certify that, to the best of my
knowledge:
Com lian Non-Com liance
� ��� No direct connection between the public drinking water supply
and a potential source of contamination exists. Potential
�,r'`� saurces 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
� L� 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
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
d ❑ for condensing, cooling or industrial processes back to the public
water supply.
� (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.
�5� Plumbing installed after January 4, 2014 bears the expected
� ❑ labeling indicating <_0.25% 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.
I further certify that the following.materials were used in the installation of the private water distribution facilities:
Service lines; Lead ❑ Copper L�J/ PVC ❑ � Other ❑
Solder; Lead ❑ Lead Free C�' Solvent Weld ❑ �ther ❑
I recognize that this document shalf become a permanent record of the aforementioned Public Water System and
that I am le all res onsible for the validit of fhe inforrnation I have rovided.
Re arks: dZ
1
Si nature of Inspector: Registration Number:
Title: T e of Registration:
Date:
White—City Yellow—Customer Pink- Inspector