Summary of Lead Service Line Inventory - Hillcrest Manor (NY1130008)

I. System Information

Water System Name Hillcrest Manor
PWS ID Number NY1130008

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

Contact Name Brian R. Congdon
Contact Phone Number (607)749-4962
Contact Email Address brianc4@rocketmail.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 15
Total Number of Identified Service Lines 15
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 15
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 15 0
Customer - Side Service Lines 0 0 GSL 15 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 15 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 0
Field Inspection 15 15
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 Contact Brian Congdon at (607)591-2770

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.

Brian R. Congdon
Name
Water Operator
Title

Date