Form Tceq-20699 - Customer Service Inspection Certificate printable pdf download

Form Tceq-20699 - Customer Service Inspection Certificate

Texas Commission on Environmental Quality

Customer Service Inspection Certificate

Form TCEQ-20699 - Instructions

General Instructions:

The purpose of form TCEQ-20699 is to certify the identification and prevention of cross connections, potential

contaminant hazards, and illegal lead materials as per Title 30 of the Texas Administrative Code(30 TAC)

290.46(j)(4). The form can be completed one of two ways:

1. The form can be printed and completed manually, or;

2. The form can be completed electronically through an electronic medium (tablet, laptop computer, etc.).

The yellow areas on the form can be completed electronically.

NOTE: The form is intended to be completed on-site while the inspection is occurring. If the form is

completed electronically, the electronic device must also be on-site for proper use of this form.

The form must be printed and signed by the Inspector that performed the work. The hardcopy original or a copy

must be provided to the Public Water System (PWS) for record keeping purposes as specified in 30 TAC

§290.46(f)(3)(E)(iv).

Specific Instructions:

Please follow these instructions when completing Form TCEQ-20699:

1. Check boxes: If completing the form electronically, all check boxes are highlighted in yellow and can be

selected to make the desired indication. Selecting a box will insert an “X” in the box.

2. Remarks: The “Remarks” section of the form is expandable, which means your final report can be more

than one page. Make sure to include all pages when submitting to the local water purveyor.

3. Due to there being three (3) different licensed individuals that can fill out this form: TCEQ Licensed

Customer Service Inspector, Licensed Plumbing Inspector or Licensed plumber with Water Supply

Protection Specialist endorsement. Please provide your title.

Form Tceq-20699 - Customer Service Inspection Certificate