HomeMy WebLinkAboutJanuary 2009 '1 MINNESOTA DEPARTMENT OF HEALTH
Section of Water Supply See instructions on reverse side to complete form.
and Well Management pyyS ID* Month of
Fluoridation Monthly Report /b ,2 0O Q 9(64"L-- 0 l
Name of Facility Street
/t,/6S 0 afil Pti4A g-14)4
CjtY County Tap Code
� AP 5-50$ �
Signature Title Phone #
P� � ' �Z2 6, 5 '13 �' `fLf3
Fluoride_UChemical Used - Flaw Water Fluoride Concentration Water Source
/ , s i ', tzc C4 7 . o . oZg mg/i , //
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) System
1 2 3 4 5 .
1 8S1 (23,5 954' a rO . /O/ Li 7110€14124.S,tFtryt
2 85a.0 70 W 3. .o • 1'.. 0 b Srr9, l�
3 535 2 5. pZ '6 L,56 1 5- , Z. 2-
4 z L, 5 3 ? 2. O • 1 0 v 5.J-iSW-ei )
5 8 L133 68 .2,o / QIL/ 77 ��`�id-
s /-a . > S !
853 93� 503 � v �
7 . 25LN73 517 •s • L. / 7 -:_/4, ' /E ---8 51198/ 508 .2.S /°3 3 .�• /Q
55,173 419a. 02.o / 3
10
1 . q W i 5-L. Z- 5 I ,? i /J4L
12 8 56,88A 39 q 1,5` /. /1. .j rn.e-0,f'-1
13 857,2 97 1-1 /..5- ' e -o 1• /.. 75� 2-de
14 .5' o2., 0 hag C- e4_,--e-- p4-uA.-
15 85ff a a9 ti9 0 cv 0 _ 1./5 ` .�/1L�
16 8587// 48a vZ.0 i is 6-peic%in.pttliy- N 17 5`I24i 53 '7 • Z- O . 1 Z . id,
18 5q La 3 Z- O L 20 . 5.A- 3 {-
� r
19 00 7, S- -3 5 ,-D•C , �- o2 aL �z�� ��r
20 0 6 0 1 5 3 Z Z . S /° 0 to 7ectmti /4n1-,
21 g.6, / / (o t ,s -y . c
1 g sf • i �_
22 e6./-7o s-4/7 a . s
5. "0-124-14---
23 <o y Y ,.a , l
8 15 a
24 % b z t,,,3 I 4 2. 6 1. 0 1 . o 1 Itraii_25 L 1 o ca i SA_ /. S' /,o q Ira /4 26 8 4 3 5 SS 9 / 6 .2,S- /- 45 c iii -,-'--e
27 8 b l/ I 3a 5 LI 1{ 01,s- /„/5 5. A. Zt1-- -
28 84 I5C8 1-16(0 :.?,0 /r/w2. G ,n. 2
29 8{6,51 1.$ 51-17 c;1. 5 /. // ' , ;',6 secitt-74-71,_-
30 8656/5 ii.7o 01. . _ /0/0 , '
• /' ' ' 'w
31 �$ Li, 1 5 Z 2- a /loS acK 74/4
to be sent back eacti month to: Minnesota De
Copy t Department of Health, Public Water Supply Unit,p
P.O. Box 64975, St Paul, Minnesota 55164-0975
HI 57.9.1000 lI-1
HE-00818-02
IC 140-0013
MINNESOTA DEPARTMENT OF HEALTH
Section of Water Supply See instructions on reverse side to complete form.
and Well Management 1 PWS ID# • Month of
r'
Fluoridation Monthly Report •
1 %V 0 0 a 0 get/it . 0 7
•
Name of Facility Street 0 t 4LA & n
I y l cs�ftv7JC
City t ?gyp Code
e/41 Ca-k "a4it /1-ev/tts^ itiet-4417a". • 4-5-0 V ---
Signature Title Phone
geg rs`�= 'f d&,- Fcrai cgs/ - '139- /t(3 9
Ruoride Chemical Used flaw Water Fluoride Concentration Water lore
a c,�� 2`(776 t- __°._.__.._ mgn I
Amount of Solution Fluoride Analysis
• Met��� - 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 • -
2 _ '
3
4
5
6 .•
•
7
-
8
9 .
10 Zc., z/ 7 .5 `3 --,
11
12 ` -
13
14 • - - -
15 .
16
17 • -
18
19
20 -
21 '
22
23
24 -
25
26 .
27 _
28
29 . •
30 .
31 6,a / 73 - ..... _. —._"
- Copy to be sent back eacti month to: Minnesota Department of Health,Public Water Supply Unit,
P.O. Box 64975,St. Paul, Minnesota 55164-0975
.a 3,o C