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HomeMy WebLinkAboutDecember 2007 MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. and Well Management Pws to month of Fluoridation Monthly Report / `baOQaO ,,ac, - c04,7. Name of Facility Street it-14% 0 alt f A /.Jz j - City County Tip Code ti- (1 0 P 7i-e-7jc "11- 5 S 045 Signs re Title Phone # glitef Ai-a161, elk,b-Gu_ u -02-61)1.47-1, 657- 4/3/- 11`l3 9 Fluoride Chemical Used , , ( Raw Water Fluoride Concentration Water Source 7 , e •i ' / G"t yx O./ro mgn il/ .eV ' --Z 1,1)aay 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 �y( 1 2 '+ 3�+ 34 • /J/ j5`. • 1 xJ 0es f7'' ;V 2 - v 1 Zs- f,7t1' I/�L G. 2 Sc1 / 0 / 44 1 2 . 0 . .40 5.4. -- 3 As 9 ./ ,) . {' I.o'7 / 7J,Ia-„ f14=- c.- 4 I0a518 687 . 3-s /.37 14 5 90 784 . 1-186 .1.-5^ /.16 etv-`'� 6 114-133 6419 3.5- /..�`f Q ,-E • et 7 • 91 'SA S 19 4.5 1.16 6,-7. e a 92.41i Sf9 Z. f. /6 S,A _ Asr • 9 1 2.9 7 t. • 50 1 Z .0 /, z.1 s.A - l✓ s 7 10 350 537 3.•0 J V dov-ei.._. i i . 9Vo ? 6-7? V ° .?1,5- 6?t /4 . ..5-- A--zG4'4 14/.2.- 12 9'itt77 341 40 1.2( • C7 Ce-> 13 5".181-16 56 9 • a.5' . /7 '7 S'c1t-oa-2. 14 "535 i • 5a5 a,5`. / 3b t m 15 1 5q /0 SS5 Z. S / , 3 ) C__//y AA4c<. 16 q b 3 71 53 3 3. 0 I . 3o CLOUEP �rK.. 17 e161y3 544, .,.s 1. 30 1a 97075 * / 3 0-5 /1442- � *a /€tI 19 9 � `- . c”) 2 d.,3-. se,,,,..,J'r'I"oi're4 1,J..- 20 9 e) W _ ,'�/ 4"� . S" A. o 6 epa 21 $ 501 2 2 . 0 / - r 3 ri. ;451,,,,,..., /ef // 'L. 22 q a 1 1 5 ( o 3 - 0 // 3Z. &ea,- Al - _ 23 clice, a. , z g S.A 6-403.1— 24 /0,e5,0 / 0 5-4.$F1. 2, v 1‘ (57 7itie".i 25 /o0if37 L'a.7 -J2,o /f /0 C v- Pa/z--01...2S /DO `Z / 4 1( L r /40 3 /tic4-,0600,7 27 /0/37 1 4`7`0 ....1(5- /.a`f .5,Ai F-c.J-t-- 28 10,881 498 .n2,5 4, 00 29 /0Z3 b3 Z - S I t IZ 30 ,,Z s lfCtil a...s' , 1, 011 �e $ 3 7A 31 /03x53 00 07. 0 !,at -i,4 , .'C! €. ` __ -—P.O.Copy to be sent back each month to Minnesota Department of Health, Public Water Supply Unit, 1 Box 64975, St. Paul, Minnesota 55164-0975 /.5",0 9.7, oo o Fl-1 c RE-00818-02 IC 140-0013 all 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 / Dp � . c ©©7 Name of Facility Street • /1116 $ o init City / ( J P `i1 e6/ County _ 71p Code Signature Title Phone # l .e€ '1 A& 7,4 - it t4 6 Si- (13 7- z7/4(-3,7 Fluoride Chemical Used -f Raw Water Fluoride Concentration Water Source 7 / ' • i' .(•tQ c f� a c�- 3 mgri 161 Fluoride Analysis Amount of Solution • 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 . • i • 2 3 4 5 6 7 8 , 9 • 10 11 12 '771k3o 315 Z. C) 13 • 14 • • 15 16 17 18 71A a7 6117 . 0/4© A 19 20 21 22 23 24 • 25 26 77' 2412-7 27 ,. 28 29 30 31 7702650 _ A.23 /-Q 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 D3 oo0 F1 ': HE-00828-02 /ti s IC 140-0013