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HomeMy WebLinkAboutApril 2007 I MINNESOTA DEPARTMENT OF HEALTH $t Section of Water Supply See instructions on reverse side to complete form. and Well Management pws to a Month of ' Fluoridation Monthly Report C G3. / /Z 9f z,C, -26 6 7 Name of Facility Street (Ci r County ` Zlp Code 4 a `FOAL PA-:L; //e-- 1 y1Ws .:4)Ac ,w5-.7,� -© � Signature � tle / Phone # 1"c4 L>c�.wh.� s_ ,Re ,.!_ pc-/-c y- `./V3_ Fluoride emical Used Raw Water Fluoride Concentration Water Source A�� i'"4�.1C2Ge�o�1�iCIG. �eCl/� Oo �3 mg/1 /we/( / 9'60 ‘.2? 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 9'6 /// 3 _ /C'5" / S- 5./ P 2 O 1(54 _ S3 '1 7 .o • / , ei 7,,,i-, .. -P/.1--, 3 P4 a.d�, _ ,S-70 A .6 . 99 ,"fee -,R 0s 4 96a63L/ y a s . a. • 1 a / 1 5 /A , "24/ 5 943a3S • _ 60 / 3"0 , 1, 6Z . , et, l✓, Gc 6 9 3 7 J'7 -7/2„4-.. a.c /..5,9, . r 7 • ` (05/ /97 _ 1170 2 , b • ), 14, /.ev/Ax-f 8 r•W; .7 O. ' ,"D5 ii?' �' ` /,/7 : •/(b CiC • 9 16SSA/ cs 505 02,s /. 33 r 10 965730. _ S� , 2..� f. og S,�`1, e-et�, - 11 . a 1 Lt Li%A ° .2. /0/5 G e.e� 12 • /64, 73S 5a I ,?,s 1. 09- 5,4 .-14.1-0 --- 13 ?6, 7016.3 5a g • ..2. 5 I.a 6 2g--7,42-hd- "h 14 1 b ? 5-5- • 5. i lOr z 7 .Q I.0 6 co�JEe (' 4)( 15 qe, iZ (o 11 Z. . s".. / 09 C/ 7 . �LL. 16 9ios� a ,36 3-s r"ao r U.. iit,i—. 17 96 95 7/ 59 7 •ar s- h/.2- t-JAc 6,A...� ,s 18 970x9.5, 5/ 4 d2, s- /"0 • ‘: C , C , i9 9 70(/8 5`x.3 c 5 /.a s 5. 20 q7116,(-1 5 416 .7,-5- . , /./ 7 , /9 77-/%/-ea- 21 c/ 7/6x29 I/65 4.5' /.0 14lete 22 970/ 78 51/9 a.. s- /, / 3 / , . x- • 23 9 7,2760 58.1. .2,.S'- 0,7 -e-77.-et 1� 24 973355 595 4,67 4. / /' 044 Qum. 25 '17388 5017 a.s f. o `5,i4/ 26 97.91181 s99 3.0 /. 0 ? C- fi t. 27 115095 6 pi _3,0 1.19 024ttuAl Po-are-1_ 28 776-6 3 5'S/fr .. s - ,1 9s- ./o w c 's 29 '7 � • .Q /r i , 'zh -b 's 30 / 77a02.7 8 01 t/, 0 o. `''a ,j- rie 31 Copy to be sent track eacti month to: Minnesota Department of Health, Public Water Supply Unit, P.O. Box 64975, St. Paul, Minnesota 55164-0975 c� F HE-00818-02 /6r 5111000 IC 140-0013 MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. ' and Well Management Pws lD # Month of Fluoridation Monthly Report • 12/3/2,dt a 007 /g9000 Name of Facility Street cal, _ County Zp Code . soak 44- 7)tzeoi; -74/4--d u • s-co % — Sig atur Title Phone # •-e 1°04-6‹. 7ri -Ci 625—r— V3 —4/4/3 7 Fluoride Chemical Used Raw Water Fluoride Concentration Water Source �it'��b�1'u ee'``C G: 0 y7 min _ -141-G-4t 6 70/. ' 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 ,. i , 10 11 12 . . . 13 - • 14 • 15 - • 16 17 - 18 . • 19 20 21 22 23 . 24 • 25 26 • 27 28 29 30 70/3.P.w Q C --•--0._.._ 31 1 - 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 F HE-00818-02 IC 140-0013