Summary of Lead Service Line Inventory - COUNTRY ACRES MOBILE HOME PARK (NY1302119)

I. System Information

Water System Name COUNTRY ACRES MOBILE HOME PARK
PWS ID Number NY1302119

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

Contact Name Donna Hemsley agent for Landlord- Country Acres LLC
Contact Phone Number 845-297-2109
Contact Email Address hemsleyd@bottiniproperties.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 34
Total Number of Identified Service Lines 34
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 34
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 37 0
Customer - Side Service Lines 0 0 GSL 34 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 34 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 4
Field Inspection 37 33
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:Bottiniproperties.com
If under 50,000 customers: Explain how to access the inventory On web site, listed under community name

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.

Donna Hemsley
Name
Manufactured Home Parks Manager
Title
10/03/24
Date