HomeMy WebLinkAboutMay 2008 MINNESOTA DEPARTMENT OF HEALTH
Section of Water Supply See instructions on reverse side to complete form.
• and Well Management PWS 10 # Month of
1 Fluoridation Monthly Report f Q
l g 4 $
1 Y
Name of Facility Street v•
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City x. County _ Zip Code
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Signature Title Phone
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Fluoride Chemi Used Raw Water Fluoride Concentration Water Source
/ � cPYZ ' 0./6 mgn ` di #0■Z
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 Iftl tia3 ,5861, .3.0 . /.35 5A At Cd.ot-
2 /401.9''./5 5 as Z 5 _ ' /, / / 1504 "0-e -
3 / (7241. 1 S-Z Z. 3- 0 1 , Z3 C;' 1/4L1. ,=. l
4 / 61155 5 / s . Z. $ . •1.. 04 S_ .� _ .
5 I635'19 .S4Y 3.0 •/..1,1 . �ta-rd1- *'
6 14t/ 130 5"81 3. o 1. 1/ . 7 5 eft,o-,o-C
7 • /61-/764 to 3? <3_,) . 4,13 0, ,4,--;/
8 J / 437 4,2.8 d.o /a 3 .
9 1 (0577C • 579 / 3.0 /r 31 1�� s., 1-,c a,
10 1 c 4 .1 1 C q c (i4k le 3- 5 C1* t.N.1 /. /5' L_� li re:.
11 , (06833 3 (,, L Z $ /. /L s4 t4i s�
i2 /67 '/'10 4,07 3.0 /, 2.1. • 7 2, e a t n u 2 4 i -A°-4 "
13 /680 419 (009 " 3.0 ./. / , - S
14 /(08438 . 3'89 3.0" / . 01, 1) . 'T ,...e,,4-
15 16 9 ea8.2. y'f 3#3_ . /. a/ 1r / l ift
16 /6. 939 f 1-g-7 ,3 5- /.A./ iOtc Caw_/�
17 12 0 s Sy f / a . Z • s 14 r 'i C ixtp4ir " f ii
18 ti I ZS l . 10 2- 3: s 1, 37 "Az eta Are.
19 171931, (07'1 3.5 /.36 rn9- f-4-4`1
20 / 7a5/7 E" 3.0 . /.3 Li T.�-f .t. .
21 1 73/44 L 19 3.5" /. /3 &41 t --CI'
22 /7,39 t) el? 41:n / Js— 5V//44T..�/bcfscJQdc
23 /7if 730 7S® 41r 0 I. 38 7 ' , S'Z
24 1 755/8 748 go /. /3 'V V"":&'-
25 /76 /di/ 743 .0 /./6, °
26 17695'0 707 3.S /, 31 .,e i°a t_,!�
_ 27 177439 631 3.�' /.g3 T" g
28 172X49 8f0 g-f.s- /,,Y5 4. E, c .
29 / 71a4.8 771 L(.O /47 c,4,
30 / 79899 Co 7I 3.o , 1<38
31 / g64,117 5 q i 3.6 1. 3 ./4/"',/ //,-/ Aft
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
HE--00818-02
C9 , 073 000 Fl
IC 140-0013
` 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 08
Name of Facility Str4//6 et
• [ 0O ff- PO-4-4- /5-J1)-41
t
City L—�J t / / y County Zp Code s-s---og
Signature Tine Phone #
.e& K-e P� r tosf_ L-f3?-y�37
Fluoride Chemical Used Gf�f� ii Raw Water Fluoride Concentration Water Source
7 7 7/76 Amount of Solution • Fluoride Analysis
Meter or Compouhd 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 . 777r7G - •
2 •
• _ .
3
4 • .
5
7 . _ • •
8
9 • .
10
11
12
13 •
14 .
15
16
17 •
18
19
20
21
22
23
24
25
26 _
27
28
/28
30 ,
31 7777 Ca (9 d 0 .�- -..
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-'c
HE-00818-02
IC 140-0013