Summary of Lead Service Line Inventory - King's School / Church NAT (NY4530092)

I. System Information

Water System Name King's School / Church NAT
PWS ID Number NY4530092

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

Contact Name Wayne Patterson
Contact Phone Number 518-694-2113
Contact Email Address wpatterson@kingsschool.info

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 2
Total Number of Identified Service Lines 2
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 2
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 2 0
Customer - Side Service Lines 0 0 GSL 2 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 2 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 0
Field Inspection 2 2
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. Church Office
If under 50,000 customers: Explain how to access the inventory 6087 State Route 9N Hadley, NY 12846

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.

Wayne Patterson
Name
Pastor
Title
10/09/24
Date