HomeMy WebLinkAboutOctober 2007 I 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 / p D a 0 O(O 06t0 i- -c (
07
Name of Facility Street
/1//b S' 0CIA `C6 t3-- .
City_ County _ Zp Code
r 7)C=2 cl Le4% A
SignatIre
Title Phone #
A) "f L ve.,z,40 7't—., 57- c/3 - 4/4/39
Fluoride Chemical Used - , - a Raw Water Fluoride Concentration Water Source
1 , I '/ 1 ' C:9'((745 0 •/(o mg/1 1fete C -
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/1) System
1 2 3 4 5 .
1 751698 65/ _ 3.5 • 1,44 rbe top-nt- f
2 75 2 303 (oos 3,o • /.0„2- ' -
. 3 "75.2.4143 &go .3,e7 1,07 7 , ' ; S.rectz
4 753557 � 1q . S. 0 x.09 _i ` "
5 7541018q. 7017 _ 3,s- • , `19 . g rr
6 7549 1g (o34 3.o /. / g C/TY IOW_
7 . , 156-q (o t , .543 _ 2-0 1. 07 Axe /kite/4'
8
9
10 756,089 (QS` 3-0 /, / Z 5.4, 74)Li-7`
11 . . 7 - 4, 7c go - d . /, ,, 3 Ui-/l� LJ
12 75737 558 .-S /,. m-5- A9-tir�O rt#"7
13 75 /213 3-3 • Z- 0 1, I I ./-I w ill AA.
14 75 cj z-rl • $-04 2-0. f zz- / ciiy y
15 `7S'R(/'�' 7 S . /I. c) 9 %�.�-.�► .-7`,ti't
16 7�9 SzO �S7 ,?• < I+ 0 / O cef-c a�� 'S.
17 159 9So 5`415' - _ • 3. 0 0. 941 �;- �
18 760530 580 3.0 /,.0a- !'
19 760 1 q91. 4/6g, .,,a /. .0( 5,A- J-14-t--
20 76,1q.6.1 t-I 59 a(.o / /'/ _ S-h-�'
21 76 Q L % 571 o15 1.07 ?Jet V
22 7(0A583 56! (2 ,5 /,/g ,71 pike-
23 , 7k,3 ! 78 .575 5 3.o !8 Pe-- -t.-
24 17( . V 76 ,.2. 1, Q S S oe )ee.,1ic Art
25 76 77 I f 7 .. / , .2,5-
C ,5 /.o 7 .49,4 -W 1.! /'
'
26 76 7 75 98 3.0 1,/� ce t p .
27 76539 9 Z z, 0 / fig
5if, //4u
28 L 5 bf 301. Z-4 7, z. �r..4 G—T
2s 2 ' (3 c9 .1-94 ,a,..- 1. 15 . 5.4. eLw
30 _ 7C47/ 551 ..2•C" / /� S�
4
31 767384? J7er .. ,-5-- 1,0s "�
Copy to be sent back each month to: Minnesota Department of Health, Public Water Supply U
P.O. Box 64975, St. Paul, Minnesota 5516 5
HE-00818-02
IC 140-0013 /& -- ;/
r
MINNESOTA DEPARTMENT OF HEALTH
Section of Water Supply See instructions on reverse side to complete form.
and Well Management pWS ID # Month of
Fluoridation Monthly Report
/C� 40 �. 0 Ce� 07
Name of Facility Street
./yt6s soak ta/ 4--a-
City County ' Zp Code
C
Sgna -e d6 Oak /10-4.A- /� I4l 30$ —
Title Phone #
- g e /. . &G- z e i c Fro 65/- ef39 10137
Fluoride Chemical Used , . a.-<-4.:=1 Raw Water Fluoride Concentration Water Source q
/ , / 0I // / ��lJ�4/Z" O f .2l mg/I 10 #.1—
76079 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 /(01 `� 0 .
7 .
8 76638 557 3.0 .y,3 j'
9 '71a3�1 . -r :.
q
S 6 a - /• 09 ti' 1 ', V
10 .5.A. /71/�
11
12
. 13 •
14
15 .
16
17 •
18
19
20
•
21
22 _
23
24 .
_ 25
26 •
27
28
29
30 ,
31 7 7.23 7 _ _____
Copy to be sent back each month to Minnesota Department of Health, Public LLWater-SuppfyUn1t,
P.O. Box 64975, St.Paul, Minnesota 55164-0975._.
is/55, €700 Fl-
HE-00818-02
IC 140-0013