HomeMy WebLinkAboutJanuary 2008 MINNESOTA DEPARTMENT OF HEALTH
Section of Water Supply See instructions on reverse side to complete form.
and Well Management pyyg lD # Month of
Fluoridation Monthly Report / c o 0 c - o . 0•6 o
Name of Facility Street
/ W6 �( OC ,4 6J
City __ County f! _ ` Zp Code
Sign� 1 off. llama . -�1 . 5-s0 8 c-
V Title Phone
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Fluoride Chemical Used Raw Water Fluoride Concentration Water Source
i , i / ip 1 # (;).1.(47. 0. /S mg/I #14/-8/_, . c9.,
77a6).50 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
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1 2 3 _ 4 5 .
• 1 77,3 / /s� , 4/l c''' , 1--- _ ,21 ,/6 k
2 773606 , `i7/ 01.5 _ / .a. _ 5 -Arl ..� -
3 7 71.417 7 . 571 3.0 _, L `( Si A. - .
4 , Z 7 i 6 5i7 51 1 . Z S' , '�. l Z _ �'re//
5 775L01 5J2 Z . � , a5 . ,�v/ v,
6 ? "15 b g6 kr Z.v • 1 , z I . c�_ly //ALL
7 •_ 7 7 6 a.O.5 9 .7.J • /. .a& , ri..440-Virts4t.7..®a
8 7764099 y��f .� 1. 33 7� 5 C�
9 . 777/ '76 4 77 0.2. c' /o /0 7i-o-,e + .Sxii+ io>‘,
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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 it �j
' 6,) °CC) Fl-•
IC 140-0013
' ' 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 0(.44‘.., 06
Name of Facility Street
/y'/6 S owe Pere. tJ
City County _ Zp Code
Signa'tGre
Tdie Phone #
/� rt, -z-i<: 2 j'�,= �-r 0 s f -4-13 - `( /3 ?
Fluorideical Used . Raw Water Fluoride Concentration Water Source
103, S,3 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 •
2 .
3 .
4 - .
. •
5
6
7 . ••
8
9
10 /Q38.b.. (oq „3, 0 1. 16
11 I0q34,8 5 06 a. /.cL/
12 /04i L, 4. -5-56 3, 0 /. 1 ` S '4- ;4 $,r .
13 IC 5 3 i 3 i • a. 0 /, 0% coUef.' ie4`e<..
14 /p.�'/06 • 5 S 3. 0 /. -1 P-4 4,4 15 /063`/0 '1841 ars . /.a-o. al /lard-L.
16 ��- "
17 /'6 7 667 /o.2�.. 's .- �[ , `tc'/ SACS
i8 /08 /03 . Lie)CO 452f5 Le 34
19 10$ 5-56 51 l , o 1, 4 r✓ C4--7 //./I•C(. AAe 1 s4-4.,
20 /0701 V Z Z. 3 0 f. Z is 5. �Esf
21 I t.t5 z 1 t: / , 14 CL oak P K
22 li 0 0 78 lit 3,0 e 2. 1 4- ra:z-e-
23 110574, 5/8 41.S ff 3 0 r,, ti-PZetnt
24 I l l 13 534 3.0 4 37 7fte ", A _ -2 ' -
25 liii,q9 517 '02,5 /.016
i i 193 5-40, a.5 /c O$ 5 ;..
27 1l0/-615 . So a_ 02.5 /c3-7 LfA_y i `.�.
28 //3,1341 539 3,0 ,/ca,R P
29 /138/0 576 ,.3;0 1.,c2B #0 -u %
30 //1142.64 1156 o,S . 1.0C S,A, C.1
31 :. I/ / 77/ 5.05 4,5 1. 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
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HE-00818-02 /f1 5/i, ° °C)
IC 190-0013