Summary of Lead Service Line Inventory - Mill Pond Offices (NY5930001)

I. System Information

Water System Name Mill Pond Offices
PWS ID Number NY5930001

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

Contact Name Paul Gigliotti
Contact Phone Number 845-629-0064
Contact Email Address prgengineering33@gmail.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 1
Total Number of Identified Service Lines 1
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 1
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 1 0
Customer - Side Service Lines 0 0 GSL 1 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 1 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 1 0
Field Inspection 0 1
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 Contact Office 914-277-7100

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.

_____________________________________
Name
Class C Operator
Title
08/04/24
Date