Granado, Eliseo City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
001892-0001 Debbie T. 11/12/2018 12 : 33PN
ENERGOV INVOICE
Granado, Eliseo (Granado' s Sprinkler Co. )
2018 Item: INV-00012887
Balance due: 0. 00
Balance unpaid: 0 . 00
Backflow Contractor
Registration 75. 00
Payment Id: 10325
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75. 00
Subtotal 75. 00
Total 75.00
CREDIT CARD - UTILITY OPS 75 . 00
Visa ************5537
Ref=2390790601
Auth=063113
2018111263CF
AID=A0000000031010
Invoice=78200620181112123144
AuthCode=063113
Entry=Chip Read
AppLabel=VISA DEBIT
ATC=03BE
Seq=78200620181112123144
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Change due 0. 00
Paid by: Granado, Eliseo
Signature:
Thank you for your payment
CUSTOMER COPY
T H E • C t T Y • O F
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City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX 75019
972-462-5150
www.coppelltx.gov
BACKFLOW REGISTRATION FORM
Registration is for one year from the date of registration or re-registration.
Date of Registration /� — �� `- ��� f �
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Name: ��/S E C.J � /�2 �4 N � l� G
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Name of Company: �i��/� � � � D S � f���/ �J /�C_ L�/� � �
Mailing Address: ;/ ��� �� �1'�j�}� j� ..S T � � ��� �� �-�^-Z� �
(Street&Number/PO Box, City, State and Zip) �
Physical Address:
(Street&Number, City, State and Zip)
Office Phone Number: �7 Z- 02 2 � �� ' /
Mobile Phone Number: � ( G/ ��`7 d_� �- ��
E-mail Address: C^� / ,S � n � �2 ,¢r1�' f� f� �� �t� � �5 rn U i L ; �' C; ��