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HomeMy WebLinkAboutNovember 2008 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 • p_oo,P c 110 ` r 03 Name of Facility Street _..it re A„ r - ( /�D b C'�cr'f 4 City ,R County * .- Zip Code / Sigelature Title Phone * ow /ç1 ' ' (th )4 -1 6s"/- C/.3 y- (lc/37 Fluoride Chemical Used 9 _ I Raw Water uo;de Concentration Water Source '_ g/ �r �� o • 4162 903 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.) Ong/I) System 1 2 3 4 5 . 1 24bao Soy 2, 5 , 01 Con ✓er P4r1( 2 ZQ �3 � 2 �3 Y Z. O i, /Z 5 i- Wes- '3 A44 793 .510 4.15" 4.11 T P--e-4-47e- 4 4 /lf5/3 S G 3..._ dx,i) 9 f{G'll Woo(• 5 4,-18813 . 379 4.5- f. 0/ . f ak—5 7. 6 Qw1a73 _ /. o.? . 7 0 • , / q 5.4 , 4t ��9 760 �(� 7 _ 1 8 Z50 t 3 : 7 ( 1L5- i // /� 't. .r' fe-0s 9 2. o a* 352- Z- c0 /� 3z c, - //4L-L 10 g51 ® ' _ 15 /�a27 '' 11 , a5 , a 1� 183 .1r0 1, 11 /'� 12 a5/9 a '-/50 2. a /.39 , 5,4, E, 13 �asawp-« cOa a,0 /, 0S 7 14 ` 4,x'11.269 R C, a, a /. /4 ,60,of5;.,,) //`s i5 z5337q 51 Z . O. . /, / 5, A- l,u s 16 z $ S SS 6 S Z. O 1, i ...g.d7 yaortn.S 18 .54liQ2 41 G:, 9 .2 -Cs /j, ay --F d4` 19 55,a:7,7 �v. ..1.0 /, / '� iS/:i%1� e � 20 4P S.S ?l '/6 L,S /" / 3 /-,^u�-.ok.,,C,j,v 4, _ 21 a_564.ta9 413 (e7 a.a . /-®G, .5_ . ° J-' 22 2s Co 6 (4 _ 4 3 S Z,O /, 19 Car -e.. s . 23 LS 1 1 ( 1 f 4i g ..0 1, 3z- 04 tL(, A- Za :;Zs 7 60/ �f�9 c2 S" /.34f 7,'-e4t 11 112 /--tetR f 25 cal,5g07 6 7 ..2,6 / /o d' _ 26 s15/ .2,.5 /0,2C s,4 , a s 53'99"7 fe i ,9:6 /' 3 / R6,.-7.-.„,c(-6 29 _ �.)' 1( y . 39 . i Y Ai/ 30 Z b 0 1 , 0 , Z 3 S -A A. Ul&s7s 31 - 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 ..■ 'if 3( 10 gi aOo MINNESOTA DEPARTMENT OF HEALTH ... M., Section of Water Supply See instructions on reverse side to complete form. and Well Management Month of Fluoridation Monthly Report iS f2 O©c; +7 0/j—,. c© i� Q ' Name of Facility Street (l • /V/6 g D 13Ad " City_ County *+ Zip Code /���-, Oat /1A - -;,v` rt CO g Sigma nalt re Tale Phone # g ,1 e &i. 2i - 'o ez,.�( 1l3?- L L/ Fluoride Chemical Used < Raw Water Fluoride Concentration Water Source f ,Ote�2rrd_ Z r—'°��. mgt x'd •Cr6 a r�L Fluoride Analysis v 3$ �il Amount of Solution Met or Compound Tested Fluoride Sampling Point Reading Pumpage Used Per Concentration on Distribution stribution 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 11 12 - 13 • 14 • l 15 . • 16 . 17 • , 18 - 19 20 2 r 1 22 23 24 - L 25 _ 26 • 27 . 28 29 30 Cis T../6 Y c73 C2 0 b ---_ 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 Fl 1