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, MINNESOTA DEPARTMENT OF HEALTH GROUND-MATER MONITORING - VOC SAMPLE/ANA�YSIS REPORT
<br /> Form SSU-3 Rev. 9-85
<br /> 5. SAlPLE INFONMTIOl1
<br /> N�er.D. �_�(�, � FiN�rMell �i I i�,li � Naaier(Public Syste�)
<br /> I�'t I`1 Ib I
<br /> Oateection � � T1�e Owner Nawe ��6 a S��(jIQ�
<br /> (24-hr, clock) ( , , , Facilit AEdress 1'- I \
<br /> M M o o r r M H M M (St.. Rte. o� P.O. Box) �p0 ►�pv��-V� St,�yhi �Gy Jt�'
<br /> Collected Oy C�VI/l SUI/� City and Zip CoCe S �G
<br /> Sa�ple Type (check v one) Lab Budget
<br /> (�-tl�Untreeted Water Nuaber �I��I�I I�� �I I�..�I
<br /> [] T Treated Water- T�eatment Type Lab Saaple Field Blank I
<br /> ❑ 0 Other Nuaber � 7 7 �C Nu�ber � (��
<br /> Sampling Point DeI[crlpti n
<br /> l�c..1���2 ` �LI�rP� edS� z�dP C�' �OUS� �ate Date
<br /> ReceiveE C� Z 7 Malyzed �(�i3�6 i(� � , �
<br /> Malys Type (check v one) M M o o r r M M o o r -r
<br /> Initial Sample � C Check Sample Date pate
<br /> (] 0 Other Confi►med Reported Z.
<br /> M M D D Y � M M 0 D Y 1'
<br /> Splft Sample? � 1'es Q�,
<br /> 6. PARISIETER AND CONCENTRATION INFOWMTION
<br /> c�
<br /> alysls Requested - Volatile Hy rocarbon - Code 465 Code VOC ``� ��``��
<br /> VOC's Detected? � Ves � — cF d` Result (ua/1)
<br /> chlorodibromomethane � _ _ _ _ _ _
<br /> cis-1,3-dichloro-
<br /> �,d�����`° 1-p rope ne ❑ — — — — — —
<br /> Code VOC d� d` Result (ug/1) 2-chloroethylvinyl ether � _ _ _ _ _ _
<br /> acetone � _ _ _ _ _ _ 1,1,1,2-tetrachloroethane � _ _ _ _ _ _
<br /> ethyl ether � , _ 1,1,2,2-tetrachloroethane � .
<br /> benzene � _ _ _ _ _ _ pentachloroethane � _ _ _ _ _ _
<br /> toluene � _ _ _ 1,1,2-trichlorotri-
<br /> cumene � _ _ _ _ fluoroethane � _ _ _ _ , _
<br /> m-xylene � _ _ _ _ _ 1,2-dichlorobenzene � _ _ _ _ _ _
<br /> tetrahydrofuran � � — trichlorofluoromethane �
<br /> - - - - '- -
<br /> — — — —�— — 1,1-dichloroethylene
<br /> methyl ethyl ketone � _ _ _ ❑ — _ _ _ _ _
<br /> methyl isobutyl ketone � _ _ _ trans-1,2-
<br /> O — — — — — — dichloroethylene �
<br /> ethyl benzene _ _ _ chloroform �
<br /> o-xylene ❑ _ _ _ _ _ _ dibromomethane �
<br /> p-xylene ❑ — — carbon tetrachloride �
<br /> chloromethane � NOr�u�TIFtE�._ _ dichloroacetonitrile �
<br /> vinyl chloride � NOT UANTIF[ED ._ _ 1,2-dichloropropane �
<br /> chloroethane � NOT UANTIFIEDl._ _ tranS-1,3-dichloro-
<br /> dichlorodifluoromethane � NOT uANTtF[ED ._ _ 1-propene �
<br /> bromaoethane � NOT�UANTIFIED1._ _ 1,3-dichloropropane �
<br /> Gichlorofluoromethane � NOT U1lNTIFIE�._ _ 1,1,2-trichloroethane �
<br /> methylene chloride � _ _ _ _ _ _ 1,2-dibromoethane �
<br /> allylthloride ❑ _ _ _ _ _ _ bromoform �
<br /> 1,1-dichloroethane � _ _ _ _ _ _ 1,2,3-trichloropropane �
<br /> cis-1,2-dichloroethylene � _ _ _ _ _ _ 1,1,2,2-
<br /> 1,2-dtchloroethane a — — _ _ _ _ tetrachloroethylene �
<br /> 1,1,1-trichlorcethane _ _ _ _ chlorobenzene �
<br /> bro�odichlorortiethane � _ _ _ _ _ _ 1,3-dichlorobenzene �
<br /> 2,3-dichloro-l-propene � _ _ _ _ _ , 1,4-dichlorobenzene �
<br /> 1,1-dichloro-l-propene � _ _ _ _ _ _ � � _ — — — — —
<br /> 1.1,2-trichloroethylene � _ _ _ _ _ _ � � _ — — — — —
<br /> Analyses Result (mg/i unless Analyses Result (mg/1 unles<
<br /> Requested Code Parameter otherwise noted) Requested Code Parameter otherwise no[ea)
<br /> ❑ nitrate+nitrite nitrogen C _ �. L�. _ � specific conductence _ � � ,
<br /> ❑ ammonta Mtrogen (�_l-� Z. iunho/cm.
<br /> ❑ chloride _ �1-— -- ❑ pM — � ' f
<br /> ❑ sulfate _ _ � � . ❑ _ _ _ +—
<br /> ❑ iron — — �' o � � — — - - --
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