Summary of Lead Service Line Inventory - Country Gardens Apartments (NY5405825)

I. System Information

Water System Name Country Gardens Apartments
PWS ID Number NY5405825

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

Contact Name Daria Fane
Contact Phone Number 917-232-3536
Contact Email Address daria@faneorg.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 4
Total Number of Identified Service Lines 4
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 4
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 4 0
Customer - Side Service Lines 0 0 GSL 4 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 4 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 0 0
Field Inspection 4 4
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. Will email tenants that inventory will be made available upon request.
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.

Daria Fane
Name
Manager
Title
10/01/24
Date