Summary of Lead Service Line Inventory - Montgomery Nursing Home (NY3510480)
I. System Information
| Water System Name |
Montgomery Nursing Home |
| PWS ID Number |
NY3510480 |
II. Contact Information for Owner / Licensed Operator of Record Completing the Form
| Contact Name |
Charles Bundschuh |
|---|
| Contact Phone Number |
845-457-3155 |
| Contact Email Address |
2817 Albany post road, Montgomery NY 12549 |
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 |
0 |
0 |
| Field Inspection |
1 |
1 |
| 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 |
Printed , available upon request |
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.
Charles Bundschuh
Name |
Director of Environmental Services
Title |
09/29/24
Date |
