Summary of Lead Service Line Inventory - Woodbourne Correctional Facility (NY5203012)

I. System Information

Water System Name Woodbourne Correctional Facility
PWS ID Number NY5203012

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

Contact Name Fernando Costa
Contact Phone Number 1-845-434-7730 ex 3950
Contact Email Address fernando.costa@doccs.ny.gov

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 41
Total Number of Identified Service Lines 41
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 41
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 41 0
Customer - Side Service Lines 0 4 GSL 37 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 41 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 0
Field Inspection 1 40
Customer Identification with Photo or other Verification NA 1
Excavation 4 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 Will be posted in general library and law library

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.

Fernando Costa
Name
Plant Superintendent
Title
09/10/24
Date