HomeMy WebLinkAboutApril 2008 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 r°g
Name of Facility Street
. /yl6 oa ion ,, .
County
1 Pic � ✓ % G . Zp Code�
"Q $ -
Signature Title Phone #
i�' ',C46-e - 21o�f - dz AA 657- ` .39- 0/39
Fluorid�mical Used � _ , Raw Water Fluoride Concentration Water Source
7 0 ' . �i rc�C c t,t2: 0. 19 mgn �kJ-at 7FZ
1q1,5050 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 /L1555'5 505 .2•5 /113 i _e.41. ut.4-'
2 / 4.1 60 7LJ 519 a-s i-38 ri,
3 /'-/6, 701 6.27 `'e 3._12 /, a 7* saiEoir-e
4 1117/34 tf 55 . . .o ,- Z 3 ,a7-e- -s -ee
5 f ? (o(ca i . 5'o c Z,.." /, /7 C4,-,.(2,/e5
6 f4icz76 ( /5- 3 r /.. o � . cw t.
7 • ti18(3A. 356 .2.0 1.33 T reetixt
8 11`1 i 5-8 .S.16 .2.c /. // ,014-co-u--At- T.�cz e
9 149686' 5.11 .6' i , 2S 5,A,
10 ISoki l 5.2,5 at5 1.31 5. A. -V ice-"
11 . 150-701 `1 $ 02,5 /.al -6 04-CtUt-02-a-
12 /5')/ `l V a �. /.. /7 <'l Y /4 4-
1 3 151655. /G A • Q, S" / . .27 'e.z.c -/2c. A
14 !sal 7O • 512. .2-57 1.17 Trz.e.44 7-..(31..c..
15 15ol 7 0 2 0 550 ae s /. a if Th-CaWy► ot-P-
16 / 53,13 `ii`i3 .2•s 1.08 Vic-lox P 'ness.
17 1538RSi 6 3,( .x• 3 -0 /.O.ro . e r e-. .
18 1541 /36 .532, ' mo /./V .5r4-. w
19 159936 .500 .2.5 • 09 11141 a-4
20 /5.C32.6 54 0 _ 3 , t> l S 15 CLOVE Pam 1-
21 15('/03 _ 577 3.0 / -37 i
22 /.5(o&/8 515 02.5 /.19 S
23 157/ /y 496 a•5 11 .2 y 7
24 /57 77/ 51 `.a. 3.5 /1 310 0�� rani`
25 1 58A .SO 979 .2.r - 1.33 G i ,vms--r '�i e-,_
26 /54 .7q2-- .s4Z 2-0 14 lZ CI AL_
27 I S 1 1.1 2 4/6 1.0 t, 0& 5 GJa-s%
28 I ER 8018 &/4 3.0 1.39 near/km-Kr f. t i
29 160 3001 Li 7Y ..2,r 1,33 7`. c
30 /4 Qg// g39 a. 5 ii 21 4, `e Gt
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
Gj i Fl-'
HE-00818-02 /51 7 1 / 000 0
IC 190-0013
r 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 SP.O Q f b s
/Name of Facility Street
• / 476 6. OadL ,ems 4-44--
City * County Zlp Code
eza . 6cit A 12 7/-e431, 5-0 SP--
Title Phone #
ot //39- y14.3.7
Fluoride Chemical Used Flaw Water Fluoride Concentration Water Source
eor. f° A
777176
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 .
1 777/ 7‘o. _
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 7 771 76 DoD
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
F
HE-00828-02
IC 140-0013