Summary of Lead Service Line Inventory - Goldens Bridge Community (NY5903428)

I. System Information

Water System Name Goldens Bridge Community
PWS ID Number NY5903428

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

Contact Name Dale Rysinger
Contact Phone Number (845)943-8995
Contact Email Address dale.rysinger@h2oinnovation.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 58
Total Number of Identified Service Lines 56
Total Number of Lead Service Lines 1
Total Number of GSLRR 0
Total Number of Non-LSL 55
Total Number of Unknown Service Lines 2
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 12 GSL 44 2
Customer - Side Service Lines 1 12 GSL 43 2
Total Number of Service Lines in the Distribution System 1 0 GSLRR 55 2
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 58 58
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

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.

Dale Rysinger
Name
Area Manager
Title
10/11/24
Date