Summary of Lead Service Line Inventory - Hudson Valley Hospice House (NY1330789)

I. System Information

Water System Name Hudson Valley Hospice House
PWS ID Number NY1330789

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

Contact Name Anthony C. Gasparini
Contact Phone Number 845-453-1515
Contact Email Address gaspipes@msn.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 1
Total Number of Identified Service Lines 1
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 1
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 1 0
Customer - Side Service Lines 0 0 GSL 1 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 1 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 1 0
Field Inspection 0 0
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. 542 Violet Avenue Hyde Park, NY 12538
If under 50,000 customers: Explain how to access the inventory

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.

Anthony C. Gasparini
Name
Water System Operator 09-18-2024
Title

Date