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HomeMy WebLinkAboutSeptember 2009 ' MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. and Well Management PWS 10* Month of Fluoridation Monthly Report S 1 Q l � aon� a .>z��c q Name of Facility Street (j7 13:340( 11/(, $ ® /2z 1-6,1- 7 City_ - r County Zip Code �— 0 Palle_ �d�G 5-Co c Signatu Title Phone # 9-in !li Pte{,-ems Vo,h4 -oz-e-rLec i . ( sir L./.3?- yy3 9 Fluoride Chemical Used r r ' Raw Water Fluoride Concentration Water Sour , oe(7o 0./G mg/I - 4 cC qSo cx, Amount of Solution Fluoride Analysis • Meter or Compound Tested Fluoride Sampling Point Reading Pumpage Used Per Concentration on Distribution Date (1000 gal.) (1000 gal.) Day (gal. or lbs.) (mg/I) 1 2 3 4 . 5 . 1 I S I 0 5'a, 756 3.0 . /. 010. G tir2.rn�-n..1"ex-x.1:74• 2 9518/ 75 8013 14,0 _ , 1. 15 -V 2J 3 ?5c 47o 795 3,5 /. O r✓ - � /` 4 g 5 loa 9 53. . 0 • - 1. 17 7f 5 ti i3gi lc (I. - 0 .1 , ZI . f 4/( 6 3' ' 3. 0 � . i Ar(c s _ 1 7 • 1 5 02-q • SS? .0 t , Z..0 S.A- I,Ao4 10 q 5 578 779 _ /,a.dt ,0 a . ` -<A.e. 12 noc,99'� _ J.o l / 9 mt e' /u�G s 13 � v / o'Z�� . .��. _ r. . 1. 4/3 °P 14 - 9 _2 �)--;' /.fir 3 '• S- J • 07 , T L'''l 15 ( lv ' 5^3 _ 5r7 ��,C�_ _ 1.0 ,3r /' -r c 7/.Z 16 J' / / 3 � �"". S 1, r3( G�cx�rA I/il Crk let 17 g..r . ♦ . .l /'/0-iv- R49 Lk) 18 6 S )- // 6 . .6 ,�- f ? /i° �7 Q l Cl . a L " 20 q 6O " Z 0 _ -s'. J. 4 c '/lay Ilt'Ct'.1 21 016,/ / 8 / 701 ,r /. 3/ r P-E/ -- 22 9700105 $8y �I.o I. 11 %� 23 9 7 5 ,7� b _ 959 7 0 1 _ °y3�..S' 1. a 4 S A� G 24 9717 5 [. S /a // t o v° 26 cR73 8, 6798 3,0 /, a. _,t? `_ ` 27 - 973891 & la 3,o /, y3 / - k _ • 28 • f I,t Q. ',�/i«ar' 29 975_/ Y5 . 646, 3.0 3.0 Lab is /� i' 30 97b / rn 77 I 3,5' bogl a'/t , 141-e--4--t- 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 ...... Pt 251 $a8; 000 ° MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. and Well Management PWS ID# Month of • Fluoridation Monthly Report _ F iqaoov_ o Name of f sty 0 a'l2 fil)tk `�� ©fie 1� � 1 uri,e av ssa% -- Sigaa' Title rT Phone # '� 'Puy'AZ h 2d� er7-Z411.-et,r1 Co s f- 'f3 - Lf'137 Fluoride Chemical Used K flaw Water Fluoride Concentration WWatelr Source / 330 Q`t 3 Amount of Solution • Fluoride Analysis - Meter - or Compound Tested Fluoride Sampling Point Reading Pumpage Used Per Concentration on Distribution Date (1000 gal.) (1000 gal.) •Day (gal. or lbs.) (1/19/1) 1 2 3 4 - 5 . . 1 . 2 3 4 • . • 5 • 6 . 7 . 8 9 - 10 11 12 ■ 13 .• 14 - • 15 . 16 • 17 • 18 19 , 20 21 22 23 24 - 25 • 26 27. 28 29 30 3'30 r3 600 0 . O 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 R_s HE-00818-02 IC 140-0013