The URL can be used to link to this page

2017_0416 � ; , � js � c��x ar�o�g�r��,�✓nr��u�z�i�s � CZTB'�OMER�ERVICE fI��SPEC�i'k014 Residential � Gommcrcial ❑ TNT2CC TD f1057404D � / C � I 7 _ upott iuspection of the pri��ate water distxibution facilities incated at , , � � � C Il wbzch is connecf�d to the City of Gappall YTatcr Sys#exn,do hereby certify � � : that,to the best of my kstowTedge; � . � � • Tn Non- T�IA � Comgliancs �ompliance F (l}• No direct c�nnection between Yhe pubIic drznking water supplg and a potantial � ' Ll ❑ � soume of contantinati.ou exists. POLBIltjH� SOUICES 6f CBACilIillll�YlO11 FiTB'I50�$iC(� � ' !' fram the�sublic water system by an aix�ap or an appropriatc backfIow pxeventian � assemb3y in accordance cvith Comrnission regvlatians. . � (Z) No cxoss-connecfion batweea the pubIic drin�ciz�g u�ater suppIy and a privaie vrater � D q syst�m�zxists, 1�hera an ach.uil air gap is not rnaintaiued betwecn the public wa�er snpply and grivate water snpply, au approved rednced pressure-r.one backt�ow � � 4 , prevention �ss�mbly is properly i�stalied and a service agreement cxis#� for annual iuspeciionand testing by a certified bac4c#law pievenkion device tester: � � (3) No conxtecrion exisis v�icfi would aIIow the rtturrt of water used£oz coztdensing ,� �] �j + coo�iag or tudus�i.a}processes baak ta the pnblie water supply, � � (4) Na pipe orpipe fitting vsrhiah corctains mare tban 8,0%lead exisfs in przvate watez �• p p � distri6udon facih`ties installed an or aftez 7uly I,1988. , � � (S) Nv solder or flux rv3aich canfains more than,0,2°/, lead axis�s in�rivat� water � �Q • ❑ E, distn'bnfion faciliHes installed aa or after 7uly 1,I988, � yr . r; L: f Watet service shall natbe pravided or restored to fhe private vvater disttihttfion fac�zries until the above eonditions aze deteruxzned io be irz campliattce. � � I cc�tiPy tha E the folla��ing u�aterials tvilI 6e used uz the installatiop of the.�rivate vlaYez dism'buUiou facilities]acated at and that tbe inspector wiI�va(idute compJiaace dezr�g the znspecrion process; � t . . Seivice lities Leaci D Copper ❑ p't)C ' p Qtki.er � Solder I.ead CI X.ead Frea � Solvank Weld CJ OtIiet � r� � T recognize ehat this document shaTlliccome a pezmaneut recozrJ of tha a�orementioned Publi�Water System and that 7 am IegalIy � responszla�� r tFie vaIidity of the inE'orma6o�T ha vided. �f � . I� Szgna afLice" ar Itegisuaii�...Numb�F 's' � </-�G-1� � Type o£Regsstrafion Date � f; . ,.: � I recognize that this d�ctunent shalI becorne a pennancut recozd of.the aforementioned PQblio Watez Sysi�m and tIiat I am fegally � r�spon�ie rtficvplidityaftheinfaimabon � ' �� j� �, f SigzzaLur�t��ect�� Regis(ration er , //� ��(�� ;; Ty�o ofxagis�afion Dat�'T" , ;' i'; � WLi¢•Custamdt CUPY Yrtiow-Cids Capy Piuk-insA�ofs CaaY � ,.-�•e=—.,,,_:�. „_..�_ _ _.. _.