Summary of Lead Service Line Inventory - Champion Park (NY3300981)

I. System Information

Water System Name Champion Park
PWS ID Number NY3300981

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

Contact Name Mike DeSimone
Contact Phone Number 315-283-2085
Contact Email Address mdes115@hotmail.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 161
Total Number of Identified Service Lines 156
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 156
Total Number of Unknown Service Lines 5
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 161 0
Customer - Side Service Lines 0 0 GSL 156 5
Total Number of Service Lines in the Distribution System 0 0 GSLRR 156 5
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 124 124
Field Inspection 37 37
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 Available by request from the water operator

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.

Mike Desimone
Name
Water Operator
Title
10/16/24
Date