Whitesboro, TX · Grayson County
Customer Service Inspection Certificate
A certificate for a licensed inspector to document an inspection of private water distribution facilities connected to a public water supply.
What this form is
The certificate documents inspection findings about cross-connections, potential contamination hazards, and lead materials in private water distribution facilities. A licensed customer service inspector, licensed plumbing inspector, or licensed plumber with a Water Supply Protection Specialist endorsement completes it on site during the inspection. The inspector provides the signed original or a copy to the public water system for recordkeeping.
Who needs it
A qualified inspector completes this certificate for an inspected connection to a public water system.
How to submit it
Print and sign the completed certificate, then provide the hardcopy original or a copy to the Public Water System for recordkeeping. Include all pages if the remarks section expands.
About notarization
The inspector signs and dates this certificate without a notary; the instructions do not identify any attachment or related sworn step.
How to submit this form
- 1
Download The Certificate
Download the Customer Service Inspection Certificate PDF.
- 2
Complete It On Site
Complete the form while the inspection is occurring and provide the inspector's title and inspection findings.
- 3
Include All Pages
If the remarks section expands, include all pages when submitting the completed certificate.
- 4
Sign And Provide It
The inspector prints and signs the form, then provides the original or a copy to the Public Water System for recordkeeping.
Frequently asked questions
- What does the Customer Service Inspection Certificate document?
- It records inspection findings about cross-connections, potential contamination hazards, and lead materials in private water distribution facilities connected to a public water supply.
- Who completes the inspection certificate?
- The form may be completed by a TCEQ Licensed Customer Service Inspector, Licensed Plumbing Inspector, or licensed plumber with a Water Supply Protection Specialist endorsement.
- Do I need a notary for the Customer Service Inspection Certificate?
- No. The inspector signs and dates the certificate without a notary; the instructions do not identify any attachment or related sworn step.
- How do I submit the Customer Service Inspection Certificate?
- The inspector must print and sign the form and provide the hardcopy original or a copy to the Public Water System for recordkeeping. Include every page if the remarks section expands.
Need something notarized?
This Customer Service Inspection Certificate doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.