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HomeMy WebLinkAboutNovember 2007 ' 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 / Uo1 (30 ,0 `7/0y", a 00 7 Name of Facility Street City .- County Zip Code 1 -zt, .Ss© g Signature Title Phone # /\) At 'f c-kJ(' o-z2- -' 6,57— '13`I- (/ /3 c7 Fluoride emical Used.- .A 7„ Raw Water Fluoride Concentration Water Sorce ' ac� u1�./6 mgn stb& #.Z. 77; 3'-t 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 '7789/ ' 6.57 3.0 " h ®/ 49.E -r. 10 �1 $34, L ho z . S _ . /, Z3 &oar aim 11 . 7, 45- z ,v t°VD Qaee/C r,e 12 75. Yo c-�93 02,S I. 0.7-. ,> " . 13 11/7 . S77 • 02e5 =17 7`: -'€ ' 14 $03 76o • 115`1 „.5" /u ,2a cove-t /'a. 15 g09 93 ( 7 3.0 . /, a.S Grvv-vn•f c re-e4 , 16 8 LI 4 L71 o�.9 -•S"- /, // .5•4. E-44-e- 17 f v q Z3 5'I 1 • 2-0 /< /O 9red& 1.4-A< 18 iai .1 C4 ic 2- 0 /- O FS 5_,4 . 4/Es?' 19 &3o0 543 .2,5- . 111 agectisx,ftt e - 20 83S 1 .5.1 €2 /..2s- q-4, ?.;€%L e 21 841,2O 51 i .2.5- i0 °s 22 0413-7 .5'� °� °O ^ /, of 4 l,tJki7 5v y �! 23 a47(794/ e-/ / e 1' _ /r / .2-- fr -/V, j jf 24 6,--1 / Z- ' g 3.O ' '. D / , Z- '3 /!D�, .a 25 15 q ? 3 (, I / � _ s JG 5.., . EST 26 8(0 LI70 97 .4.O /e08 T Al 27 7 - S--- :s;-/ 2 . _ A 3 6 nm ` e 28 57187 ava. /. r /a0A V ' 7-. +.i 29 & • , ff9 c2. S /. /.2.. 7� s . 30 i 8,a,,a 1 538 02.5 /430 31 Copy to be sent back each month to Minnesota Department of Health, Public Water Supply Unit, P.O. Box 64975, St. Paul, Minnesota 55164-0975 Fl_ HE-00818-02 �.. u f -3,33:000 IC 140-0013 jro it, MINNESOTA DEPARTMENT OF HEALTH • Section of Water Supply See instructions on reverse side to complete form. and Well Management ' PWS ID * Month of Fluoridation Monthly Report /$a(90 0 `Vey-. .cP O °7 Name of Facility Street • 1 City — County .- Zip Code 0 00Gl(. f 4— y 1)CA--14...4411 r• • 5150%a— Signature Title Phone # ak& A} , ,u ?k)--/% 7c re/ (Sl_ 137-g4f37 Fluoride Chemical Used Raw Water Fluoride Concentration �W_atter Source e. .y , / , ', -' a'` a y� mg/I t -ea fvZ 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/1) .. System 1 2 3 4 5 . . 1 7, S 791 , .a. .2 . 4o • 1, 011 2 w 593 3.d 1<05 T ®-QCLt • 3 71/39%t 4i ' z. o /, 02 S •4 E sT 4 7056,4 S $s4. 3 ca j, 0 CLOVE Mai 5 7700,23 1-1S4I Q..a • .. 97 T .,, 6 770506, t"I8.3 2,0 /48 - y S 7 . , 770997 '191 ,o t.al . •, Ef C. 8 77/.278 ,:18 I /.S /47 9 . 10 11 ,. 12 • 13 14 • 15 • 16 17 , - . • 18 19 20 21 22 23 24 , • 25 26 . 27 28 77/6/5 337 /. s . 29 . 30 . 31 Lowy to be sent back each month to Minnesota Department of Health,Public Water Supply n j P.O. Box 64975,St. Paul, Minnesota 55164-0975 HE-00818-02 3,,7e-tt; oCO IC 140-0013 tL