Summary of Lead Service Line Inventory - Champion Mobile Home Park (NY4410156)
I. System Information
| Water System Name |
Champion Mobile Home Park |
| PWS ID Number |
NY4410156 |
II. Contact Information for Owner / Licensed Operator of Record Completing the Form
| Contact Name |
Randy T Perry II |
|---|
| Contact Phone Number |
3152760725 |
| Contact Email Address |
r.perry0320@hotmail.com |
III. Summary of Inventory
| Total Number of Service Lines in the Distribution System |
38 |
| Total Number of Identified Service Lines |
37 |
| Total Number of Lead Service Lines |
0 |
| Total Number of GSLRR |
2 |
| Total Number of Non-LSL |
35 |
| Total Number of Unknown Service Lines |
1 |
| Service Lines |
Lead |
GSL or GSLRR |
Non-Lead |
Unknown |
| PWS - Side Service Lines |
0 |
2 GSL |
36 |
1 |
| Customer - Side Service Lines |
0 |
2 GSL |
36 |
1 |
| Total Number of Service Lines in the Distribution System |
0 |
2 GSLRR |
35 |
1 |
Service Line Identification Methods
| Identification Methods |
PWS- Side SLs |
Customer-Side SLs |
| Historical Records |
0 |
0 |
| Field Inspection |
39 |
39 |
| 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. |
6258 US highway 11 Canton New York 13617 |
| If under 50,000 customers: Explain how to access the inventory |
post at mail box |
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.
_____________________________________
Name |
operator
Title |
10/11/24
Date |
