Summary of Lead Service Line Inventory - Contry Club Estates - Antlers (NY2820402)

I. System Information

Water System Name Contry Club Estates - Antlers
PWS ID Number NY2820402

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

Contact Name Patricia Clemente Huckans, HOA President / Randy Gardinier Operator
Contact Phone Number 518-441-9390 / 518-848-7248
Contact Email Address patricia.realestatecenter@yahoo.com / rgardinier@hotmail.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 26
Total Number of Identified Service Lines 26
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 26
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 26 0
Customer - Side Service Lines 0 0 GSL 26 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 26 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 26 26
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. Address:
If under 50,000 customers: Explain how to access the inventory Request from owner or by writing to HOA at P.O. Box 259, Fort Johnson, NY 12070

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.

Randy Gardinier
Name
Operator in Responsbile Charge
Title
07/24/24
Date