Summary of Lead Service Line Inventory - Kountry Knolls Trailer Park (NY0101643)
I. System Information
| Water System Name |
Kountry Knolls Trailer Park |
| PWS ID Number |
NY0101643 |
II. Contact Information for Owner / Licensed Operator of Record Completing the Form
| Contact Name |
Jeff Moller |
|---|
| Contact Phone Number |
518-895-2976 |
| Contact Email Address |
mollerj1957@gmail.com |
III. Summary of Inventory
| Total Number of Service Lines in the Distribution System |
16 |
| Total Number of Identified Service Lines |
14 |
| Total Number of Lead Service Lines |
0 |
| Total Number of GSLRR |
0 |
| Total Number of Non-LSL |
14 |
| Total Number of Unknown Service Lines |
2 |
| Service Lines |
Lead |
GSL or GSLRR |
Non-Lead |
Unknown |
| PWS - Side Service Lines |
0 |
0 GSL |
16 |
0 |
| Customer - Side Service Lines |
0 |
0 GSL |
14 |
2 |
| Total Number of Service Lines in the Distribution System |
0 |
0 GSLRR |
14 |
2 |
Service Line Identification Methods
| Identification Methods |
PWS- Side SLs |
Customer-Side SLs |
| Historical Records |
15 |
0 |
| Field Inspection |
1 |
16 |
| Customer Identification with Photo or other Verification |
NA |
0 |
| Excavation |
0 |
0 |
| Sequential Sampling |
0 |
0 |
| Statistical Analysis/Predictive Model |
0 |
0 |
IV. Inventory Availability - The inventory must be available to public
| If 50,000 customers or greater: Posting the inventory online water system's website. |
Address: |
| If under 50,000 customers: Explain how to access the inventory |
letter to all tenants explaining no lead in system |
V. Certifications
By submitting this form, I have verified and certify the information listed in this form is true and accurate to the best of my knowledge and belief.
_____________________________________
Name |
owner/operator
Title |
Date |
