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HomeMy WebLinkAboutFebruary 2008 a MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. and Well Management pyyg ID # Month of Fluoridation Monthly Report / goo,, ,- .O. Name of Facility Street f 6 g Ocz ,Cu-)- 6.f-r.-te', City. County — Zip Code Da-k- /L 71-"---11 dui-/ s-SO Signatu r e Title Phone # ' ` ' \ fRij-6;c 4)zii 1�`--652 -,oz e.i1 co S/- Y39 9 r WS? Fluoride Chemical Used ,. .,. Raw Water Fluoride Concentration Water Source i j y 0`7'.7, g mgt (�-/77/ Amount of Solution Fluoride Analysis Meter or Compound Tested Fluoride Sampling Point Reading Pumpage Pum a Used Per Concentration on Distribution m Date (1000 gal.) (1000 gal.) Day (gal. o r lbs.) ( g/)l System 1 2 3 4 5 . 1 //53a 1 _ 550 3.0 1. 2 -,. f q 0 • D _ / / 8 be'E leKe �/ 3 , // 6 :?3? Z-'4 _3 0 /y Z6 LLCv /e �- 1C _ 4 //4 k9 _S`. "a a).0 • 3 O ..,,r.�--44-1:2_,4A-7"" 5 // 73aW 'la 9 02, 0 •/.37 . s 0 3 a...6 43.3 �.,..:. 118301 93 ,s 1, 31 Ce z po-u et - 9 I . z7 �3 i7 3- 0 /, i3 t ". 10 ) /17 ,x"4 4 s- 1 _ 2- 5 / , I7 4. e ,6'c 11 . . Jap (o4 510 ,2..5` /. 3,3 Pwrd& 12 m0767 S03 4, S // era "-• i3 /. I 30 535• 3.0 l3 ?1. T 1-- 14 t d 1717 915 •5 /. 3, O, � / --G 15 / aa46 ta _ Li83 .7-5 /oo . / _ 16 i ZZ 9 ZZ 54 Z 3, 0 , /• Z1 ��. 0 _ 17 121 3 0 Z 4 0 • 1- 0 f, 4-3 ,i;0014-- I2ss4-0,, Ci4t// cL 18 1 • _375 4-1( 6-GQ G. , O /cal( .5iA, .'{/.. - 19 J.;k43/8 S60 3.0 /a30 / 4,n7` 20 _/,A 4-I 2 43 5.25 3.0 /, y5. ' 21 /• s 31 70 a-5 /.30 fit, z � - 22 /,�.5' 9 3 6 /0 S.c� I. All E �su el/ s 23 / Z io.3 5/ 5- 7 Z. r Z. 0 f Z3 eerett. �4/,e,. 24 1269_2 SZ.9 3. O ii C 1 c4e44'rc"r- 25 1a7Y�b y cm 4.5 i./3 Try ela- ' 26 /a80 /a 5941 3.© _ y. 36 o-wR-", 27 Joti$531 5'l9 .02.5 1 , 33 28 I.A9O5I 5,20 ‘2, 5- /.3y G eat' 24 la/603 53`x.. 3,0 /*37 _ 30 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 HE-00818-02 /L/l $3a, 000 IC 140-0013 I MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. and Well Management PWS 10 * 1 Month of Fluoridation Monthly Report , ,it _00 o� 0 " 0 q Name of Facility Street O p � Cou Zp Code © ! � 'E;�=j -if SAD $ �- Si gnature Title Phone # k..e 7 'et,t-r e 657- y3?-4{((37 Fluoride Chemical Used . . e n,0 Raw Water Fluoride Concentration Water Source -f� !� 7 , . • ', • / wz mgii - v(/ 'TT a- 777/7< 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 . 2 • • 3 4 • 5 6 ' • 8 • 9 ' 10 11 ,, 12 • 13 ' 14 • • 15 • 16 17 _ 18 • _ 19 , 20 . _ 21 22 23 24 . 25 26 . 27 , 28 _ 29 77717(0 (,OG. 30 , 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 FT HE-00818-02 IC 140-0013