HomeMy WebLinkAboutOctober 2009 MINNESOTA DEPARTMENT OF HEALTH
J.,' ItM Section of Water Supply See instructions on reverse side to complete form.
and Well Management PWS ID• • Month of
Fluoridation Monthly Report /1:000c,00 . (9e; l. ( p cI
Name of Facility Street Q 6 /4e%!/ eit ef
Ciity Zp Code
County �--
oak / -70 / , • 5---5-0
Sig to
ra ����y � Title Phone #
/� f(4,h-e i z- i & s 7 - `-1 3 Q - `/(39
Fluoride Chemical Used -/ - r Raw Water Fluoride Concentration Water Source
/ , f /1 uG 0. g6 mo
Amount of Solution . Fluoride Analysis 1.1 LI
-Mete or Compound Tested Fluoride Sampling Point
Reading Pumpage Used Per Concentration on $�b on
Date (1000 gal.) • (1000 gal.) -Day (gal. or lbs.) (n19/0
1 qq2 3 4 . 5 .
1 , 17(06/ 7 e 1 3 3-5 • I-_ca ? i - AA'
2 ,
4
5 — .
6
-
7 . , 977330 . , .513 r. 1e� /3 ` i ' " S ectztoi�,
8 .5`""" , •. � �
4
??r y/ZC? Ae-) . R.C) /.Dad.. i` . // "
10 978c/34 LI L1 _ 07-0 . . /c /7 , ,S, r
11 . ' 79y6,3 5g. 9 ° .5 37 - _A-It (1 )
12 " 6G �r1 .• , 0/- q li
-
' l 0 I / 0 /.. 41.i�I
14 ' - 9 81057 . .3 I a,
S' /.,2.o ', 'vzv-e2
15 , �j$ 14 73 '-I 4& A, a . , 1.3 7 . .� .
16 R8 l ! /a -5'' c2., 6— ♦ ��: , 4r
17 SSZ3 5 D •- Z. o - ' l ZS(. . , 1�-
18 9 Z 1 <I 13 Z.p _ /, 33 T
19 9 V cid y- - ‹S'7,-) ,, .- --C.— _ ie /.? L 12.44 to--t7CY0frgir
20 , 983 °7gq .3 (03" , /.S`. /• 07
21 , 9S y3�.5 5 76, 3.o /,09 6<, e, �
22 9898 '18 '/ 3 A.,0 _ /,a2-y . -I yd -w-e .
23 , `38 lets' , ,350 /. 5- /.05 t. I / '.
24 7f?
5 7 6, _ s": g- 4P- ,x' /, 3 a
51A-e/0 0
25 ► .. d w �
26 /R .6002 a. LI(o / a f ■ e ./ 5, Q r '
Z
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27 i 67 /.56 53 k e 5 . /� ,? ,7-, 1-10‘,/.0./—
28 76y R7 _ .
,�. d Ti,.
29 9 k fq s / _3 / //"�
30 e . S ; /
/ IQ �/
31 ' ' i i ' i 0 , - r l r
Copy to be sent back each month to: Minnesota Department of Health, Public Water Supply Unit,
P.O. Box 64975,St. Paul, Minnesota 55164-0975
MINNESOTA DEPARTMENT OF HEALTH
Section of Water Supply See instructions on reverse side to complete form.
• and Well Management PvvS ID* Month of
Fluoridation Monthly Report p b a 0 0 g 0 . OC,, J ,�, Q 9
Name of Facility U�"c./
.- County Z+p Code
e7, ,d - ,, 064 /uk 1 X1)0��, ��� 56.0S
Title Phone#
i '0 i /1J r fcr %1 ( 5f- y39- efii3 .7
Flu. "de f Used 'I_ c r et,e_4„.7d Raw Water Fluoride Concentration Water Source
/ r v�`l�J°0 0/�a mg/i '.e2 Cp
0 Amount of Solution Fluoride Analysis
3 ureter or Cocnpouhd Tested Fluoride Sampling Point
Reading Pumpage Used Per Concentration on Distribution
Date (1000 gat.) (1000 gal.) •Day (gal. or lbs.) (mg/!) System
1 2 3 4 . 5 .
2 j S''>'7 6 90 • /
AO ., sT Flls
3 a> / S7- j, d G . f' 0, ,e_/c/',
4
4 . 4` ? . .S
, - .1. I/9 to
5 33 .8/ - 6 H$ 3,S /. 3 R' fri14--
6 ?3 3 g-s-R s7)- J _3,0 - /e .2 / . /3,'r.4,4-A- s
7 .
s
9 -
J , ,
10
11 r
- -
12 •
13 ,
-
14 -
15 .
16
17 .
18 .
•
19 _
20 •
21 .
,
22
23
24 - .
25
26 • .
27
28 _
29
30 _ . _ - • ,
31 , -
- Copy to be sent back each month to: Minnesota Department of Health,Public Water Supply Unit,
P.O.Box 64975, St. Paul, Minnesota 55164-0975
RE-00818-02 :to
95 ' , oOO 1,
IC 140-0013