Summary of Lead Service Line Inventory - Country Crossing (NY3530071)

I. System Information

Water System Name Country Crossing
PWS ID Number NY3530071

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

Contact Name Ann-Margret Stewart
Contact Phone Number 845 294-3750
Contact Email Address astewart@deblock.org

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 68
Total Number of Identified Service Lines 68
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 68
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 68 0
Customer - Side Service Lines 0 0 GSL 68 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 68 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 68 68
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 Requesting a copy by calling or emailing operations office

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.

Ann-Margret Stewart
Name
Project Manager, DeBlock Environmental, LLC
Title
10/09/24
Date