Summary of Lead Service Line Inventory - Saint Mary and Pope Kyrillos Coptic Orthodox Monastery (NY5501284)

I. System Information

Water System Name Saint Mary and Pope Kyrillos Coptic Orthodox Monastery
PWS ID Number NY5501284

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

Contact Name C3ND Environmental Consulting
Contact Phone Number (845) 244-0129
Contact Email Address caitlyn@c3ndenviro.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 11
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 11
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 11 0
Customer - Side Service Lines 0 0 GSL 0 11
Total Number of Service Lines in the Distribution System 0 0 GSLRR 0 11
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 A copy will be available in the office located at 2080 Route 9W Bldg# 5 West Park NY 12493

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 Dongo
Name
Operator
Title
11/21/24
Date