Summary of Lead Service Line Inventory - Kayadeross Acres MHP (NY4510771)

I. System Information

Water System Name Kayadeross Acres MHP
PWS ID Number NY4510771

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

Contact Name Don J. Coalts
Contact Phone Number 518-361-4438
Contact Email Address donjcoalts@gmail.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 141
Total Number of Identified Service Lines 0
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 0
Total Number of Unknown Service Lines 141
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 0 141
Customer - Side Service Lines 0 0 GSL 0 141
Total Number of Service Lines in the Distribution System 0 0 GSLRR 0 141
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 0
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 LSLI will be printed and hand delivered to each address in the park as wells as on the NYS Website

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.

Donald J. Coalts
Name
Designated Operator
Title
07/27/25
Date