Summary of Lead Service Line Inventory - Between The Hollows MHP (NY0200866)

I. System Information

Water System Name Between The Hollows MHP
PWS ID Number NY0200866

II. Contact Information for Owner / Licensed Operator of Record Completing the Form

Contact Name Nicole Spierling
Contact Phone Number 5858081526
Contact Email Address monseq1803@yahoo.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 23
Total Number of Identified Service Lines 20
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 20
Total Number of Unknown Service Lines 3
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 23 0
Customer - Side Service Lines 0 0 GSL 20 3
Total Number of Service Lines in the Distribution System 0 0 GSLRR 20 3
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 0
Field Inspection 0 23
Customer Identification with Photo or other Verification NA 0
Excavation 15 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 Can receive copy from contact and copy at local health department

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.

Nicole Spierling
Name
Owner/Operator
Title

Date