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HomeMy WebLinkAboutOctober 2010 • M I N N E S O T A See Instructions on Reverse Side to Complete Form MDH SECTION OF DRINKING WATER PROTECTION PWS ID# - Month of Fluoridation Monthly Report(Single Well) I ga OO a0 ` 9t!. t O9C/0 Name of Facility Street 0-2,3/V� G rte4r. 14168 Oak Park Blvd. N. City _o Operator Name(Please Print) Zip Code Oak Park Heights Cr 1-y or ©qK PA12k /fE16r HT5 55082 Signature Title Phone# /iri>fi / • 'i� P ,?- 651-439-4439 Fluor.a Chemical Used . . .,A Raw Water Fluoride Concentration Water Source ogiin O. a mgll ...e Metgr (P 1 mo pg Ia Amount of Solution Fluoridation Analysis Date (1R000 grid. &Mr t�ay (gal./lbs.) TGested Fluoride Sar�tlinaPgint 5047 on?enntrlatlon on System Day# 1 2 3 4 5 1 50(0 115 / 7`f . 5 I. / S s !a"'to ()a1 2 510 , 5 3 70 /. 5 1,0/ 5,tarci . 3 51 17( / a/ . 5 • 19 CA.. Attle 4 S/s'.S-9 e3 t?3 .4 s- /./' 7 5. 5',,24P 5 5 / -7a s" / .6 s S-' I. 17 & - Ark . 6 5 /3 ASS J. S j' 16 G.t.-nt' 7 594. 71.1 c•• (P1 1.s 1. 17 sK mo w, 9 s z � 5 ( 1 i i 1- 0 /. As- Cr 10 6 3 0 3 $ / 0 • 0 /. 10 ,t/ //l3 11 535 0 8 X 70 .(5 /4 /5 (g . e / C, 12 5 3 Co ¶'3 i `/ 1A a 6 ! . o C t„,... ...^ -rce-t.. . l- ft...- 13 5318 43 1 $ • 5 /. 17 t���h->) - Pam 14 e. ,>` r�. 7 O 465e.-'/Y�p?a/!(.-ad C-c. s 15 1I / J/. I_` ) t. 1. 1 AA' f y T 16 6 q 2 -e) `fig / , � 1. // 3u - k_/7 17 02 5'� /0 `7 r','i Al 18 55 / Co 6 /3 • 5 /. v'-/ c�.t t- / t.. a-r 19 55 t^/ 0l , a Li© /. o 1. 7 r� -P d .�.- 20 s'S 1 y 1 3 ? 3 i . A/5" g4449-,r144,121 Leie 21 35 < / 0 I / 10 1. jii ce.t.r P ..nc 22 a'1d V a I . 1 / 1401,1 23 S~1 6 d 6 /./6. CA-3 11-J 1 24 .3S-TSl U ('>l p l . OS— S.r r wGS I' 25 �S S t (7 O 6 1. z-s— C'f tiv,Plr'l....e.4,+- G44w4-.r 26 5515/ 0 ) ,0� U /.ab S rp � 27 /�� v7 tog. � I. S I ./ 0 �.G�ni'�l`1 I 28 S Ca R1.I - 1 il--0 1 • U I ..c 3 5✓Pe"(Arvoeir I'c A.. ei4A.c I 29 5 (:)5aL( A7(o 1 .5 . 97 18 30 5(0 740(0 aye I. 5 1,0 / eu. 6.x24 8 31 560 / l 1 I Lis . 5 ,. o3 opy to be sent back each month to: Minnesota Department of Health,Community Water Supply Unit,P.O.Box 64975,St.Paul,Minnesota 55164-0975 E-00818.02-IC 140-0013 �� / Q©Q FI-single Rev.10/20C °'" SECTION OF DRINKING WATER PROTECTION S S c to on Rev. - S • -to oil,to : Fo IVIDH �NS1�` Month of Fluoridation Monthly Report(Single Well) j ; v.d 0 D 6 4 , a 010 Name of Fac city Street /0 / 14168 Oak Park Blvd. N. City / Operator Name(Please Print) Zip ode Oak Park Heights of 0 • 4/2k E%4f(TS 55082 Signature e • one - radik ' //, ; � 1,0,,.�, 651-439-4439 Fluoride M emical sed - Raw Water Fluoride •ncentration ater Source " �� a,c�dl. / mgll -€14 a.. Date ead)n gig ,e) Amount of Solution Fluoridation Analysis (1000 gag) �lse��l�r°�a„ ��7$`o (gall s.) Tested F ride V,Iin :tall! Con ;in.g . on on on , Day# 1 2 3 4 5 1 0 1 /•0 WMINIMIESN 2 -_b : 111M11111 it 0 • 0 n► 3 �ni��■■ Co /•s �L� 4 d s-3 .,,,� /, C I, l'7 6 WENELVIIIIIIIIIIIIMIIIIIIIIMM11111 /, 15 ,.,_ - ._ 7 7- - 0 3 a ■ ,t .., __ . 8 £ 0 . , . /., a0 P.r. —k..),,t As V!■ 3 s5 /• sMIN 10 Enr ■ • 1111 z O D V L u LI��✓LLLAIM 11 7 0.2 • 0 WAMIIIIIII 12 7`1ilI $ 7N Inn= 1. 0 a IMITRIPPIMIA, r 13 0_ 1. 5 ♦ ' . i 14 el I( ,0 ! o / 15 7 53(o 1 r yh9!a/ li ? t - WAN M 16 - J t.5- , d'Q /- 17 "' I 18 . pZ. . . 0 !.._./ ,'_• 19 0 /r 0 �c� iEri 20 1 to 1 I MEM= 1 . 0 /,/s— , ,- /P ev244 Lie t 21 71 ) 06-/ 3/ S A. C.D ■ t3(u ,'a lh_ 22 111 �i' 1 . I 1-101,1 23 7 £s 1/ MERMINI ) . 5 1. 1 M' 25 1 1 o.5 3 5-0 A. 0 1 • Z 5 - 26 IffinaMillingligigall 2. 0 _ • t.. ri �..� 27 -7 / / C / f.i )C / G S V\� . / _�. r 28 a 00 $ • /• 5 1∎ 0 /.. ' __ 29 . 03Li BERM= /45 11163211111102VmhuMM 30 065 © 5 /. o r0 / ze24J, 6- - - • 'o to be sent back each month to: Minnesota Department of Health,Community Water Supply Unit,P.O.Box 64975,St Paul,Minnesota 551640975 E-1,•18-02-IC 140-0013 Fl-single Rev.10/20C 99I ( , 400