Form Tceq-20699 - Customer Service Inspection Certificate Page 2
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2Texas Commission on Environmental Quality
Customer Service Inspection Certificate
Crown Ranch Water System
Name of PWS:
PWS ID #:
1700781
Location of Service:
Reason for Inspection:
☐
New construction
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Existing service where contaminant hazards are suspected
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Material improvement, correction or expansion of distribution facilities
I
, 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
Compliance
Non-Compliance
(1) No direct or indirect connection between the public drinking water
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☐
supply and a potential source of contamination exists. Potential
sources 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 a
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☐
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.
(3) No connection exists which would allow the return of water used for
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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
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private water distribution facilities installed on or after July 1, 1988
and prior to January 4, 2014.
(5) Plumbing installed on or after January 4, 2014 bears the expected
labeling indicating ≤0.25% lead content. If not properly labeled, please
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☐
provide written comment.
(6) No solder or flux which contains more than 0.2% lead exists in private
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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:
Lead ☐
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Service lines:
Copper
PVC
Other
Lead ☐
☐
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Solder:
Lead Free
Solvent Weld
Other
Remarks:
I recognize that this document shall be retained by the aforementioned Public Water System for a minimum of
ten years and that I am legally responsible for the validity of the information I have provided.
Signature of Inspector:
License Type:
Inspector
License Number:
Name(Print/Type):
/
Title of Inspector:
Date / Time of Insp.:
A Customer Service Inspection Certificate should be on file for each connection in a public water system to
document compliance with 30 TAC § 290.44(h)/290.46(j).
TCEQ-20699 (Rev. 11-01-17)
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