Loading...
HomeMy WebLinkAboutFebruary 2007• MINNESOTA DEPARTMENT OF HEALTH , - T . Section of Water Supply See instructions on reverse side to complete form. and Well Management pyyg ID#f Month of Fluoridation Monthly Report ' / S 6) ,0,: o `"F-e-G—:, a 007 Name of Facility Street • / fi f9 , 0a42 ? 0, v' City County Zip Code £ Cl 0 /&A �-c o�� --it) , sS"o g --- Sign re Title Phone # 0"7.1,72 -t - , — `f3 -y =mica, Used . Raw Water Fluoride Concentration Water Source i 1 ■ 9301367 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 9306 7(4 535 .2 . 5 • I, 42- G 2 931 180 504 .105-- - • x. 15 z , • v ' ' 3 �1 ns 1 7 Slio. S1,7 .2. .5--'' /.. 1? , `/' 5 4 5.3a/ 93 y3 7 .2 .o• _ • / # -/ 5"//evo 5 973c7s'3 3-00 a. s' _ • / . / 3. r•e- -�. -1 6 933aa 7 L17L! �z_s /- /fo . i'11 7 • 933775 568 0Z.c • / ./3 d- , C . 8 473 L/a 4a y y 7 01 - o /-r3 ?J --1-47 -g_ 9 "93L/8.7a CD 3o 3. o /. /o /3 - .- 10 of 13 3qD `/ G98 2., .5- _ ' , . �'-/ 11 • 9, '3_ 73 Li/ 3 " . , . J 1, /G g1g bs 12 • 9.V0634,5 85a 3.5 1e /7. . .ue•tr),,e4LIf 13 ti37=2,/ 9 6/y• est s- /, o/ 5-A .li _ 14 937685 • 4166 a.o 1,s /9 S.4. 15 '3 :a.73 5 : : .24,8- o, '8 r- ' .,,,A-r. 16 `13$ 7.5`,3 `/80 a,s- 1 1. 15 r , ' /'- 17 939A,a8 175 • 02. 5' ,,aa 5-M 18 93979 S/6,f c, , 5 /`O �� 5� 19 • 0- r0 1V r ` .0 /...2 6 �" 20 gyo8o9 5yx .2,5-. ,zi 'ate 21 9i [ 5a.. 51f a , 5 /, �4 /. 22 (lilt 31 575 Z. 1iLI c a,,-� 23 y 4z4 i 54 3 7_. o / z 5jd✓ GVc1/s 24 4IAZCL7 0.(� Z. o Z 6,' 'it /11nL-- 25 91 4 o 1 G l;o �1� t Qua 9 26 `1143$5-G 366 ! 5" •75 if f-410-- pp-1.3g 7 `f 611 a -o /•0 Co C 2'i f' fz__._ 26 911,1875 Sa8 02- 5- h03 i 5 - 29 30 . 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 HE-00818-02 ! 4 736, 0©0 F IC 140-0013 MINNESOTA DEPARTMENT OF HEALTH Section of Water Supply See instructions on reverse side to complete form. and Well Management PINS to Month at Fluoridation Monthly Report • S .q L h 1�` t� 0 07 Name of Facility Street t� �(' • • •/q( Ca-A- ,4 ;ii- -- City. County Zp Code / SiggnIt ae i�G' Title y Phone # Fluoride Chemical Used . Raw Water Fluoride Concentration Water Source //f� #c �,L,,,�/Li��.yyl,�r�. 1GG•�' Q�vG��� °� ��Cst i �" 70/3 AG 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 11 12 13 14 • • • 15 • 16 • 17 18 • 19 20 21 22 23 24 25 26 27 28 7C/ 3,2 29 30 • 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 ^ F HE-00818-02 fv} IC 140-0013