Summary of Lead Service Line Inventory - Bloomville Water District (NY1200250)

I. System Information

Water System Name Bloomville Water District
PWS ID Number NY1200250

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

Contact Name Jeffery Lee
Contact Phone Number 607-267-6872
Contact Email Address voswwtp@stamfordny.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 80
Total Number of Identified Service Lines 66
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 66
Total Number of Unknown Service Lines 14
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 80 0
Customer - Side Service Lines 0 2 GSL 64 14
Total Number of Service Lines in the Distribution System 0 0 GSLRR 66 14
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 80 1
Field Inspection 0 45
Customer Identification with Photo or other Verification NA 20
Excavation 0 0
Sequential Sampling 0 0
Statistical Analysis/Predictive Model 0 1

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 Posted at town clerk's office / Mailed

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.

_________________Jeffery Lee_____________
Name
___________________Chief Operator__________________
Title

Date