Summary of Lead Service Line Inventory - Village of Interlaken (NY4901194)

I. System Information

Water System Name Village of Interlaken
PWS ID Number NY4901194

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

Contact Name
Contact Phone Number
Contact Email Address

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 325
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 257
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 68 257
Customer - Side Service Lines 0 0 GSL 241 84
Total Number of Service Lines in the Distribution System 0 0 GSLRR 68 257
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 17 12
Field Inspection 9 185
Customer Identification with Photo or other Verification NA 0
Excavation 43 43
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

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
_____________________________________
Title

Date