Summary of Lead Service Line Inventory - Gore Mountain Ski Center (NY5611822)

I. System Information

Water System Name Gore Mountain Ski Center
PWS ID Number NY5611822

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

Contact Name Mathew Moffitt
Contact Phone Number 1-518-251-2411
Contact Email Address mmoffitt@goremountain.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 17
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 13
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 4 13
Customer - Side Service Lines 0 0 GSL 4 13
Total Number of Service Lines in the Distribution System 0 0 GSLRR 4 13
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 2 2
Field Inspection 2 2
Customer Identification with Photo or other Verification NA 0
Excavation 0 0
Sequential Sampling 2 2
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 hard copy will be available in our venue administration.

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.

Mathew Moffitt
Name
Water Operator
Title

Date