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HINNESOTA DEPARTMENT OF HEALTH GROUND-WATER <br />Form SSU-3 <br />ITORING - VOC SAMPLE/ANALYSIS REPOff <br />Rev. 9-« <br />=^==^^^=^=^^^=s=s=^==sssasE:s <br />s. sMvu liNMNiiriai <br />Field Nell iMiNn <br />rial <br />I |&|9^|~7| (2d-l»r. clock) <br />01 0 <br />Collectdd kf 1 <br />Meter Sjrstea <br />Rene (Public Syitp)____ <br />ft«»er Met LmA uq 'UA Fav^l <br />FeciIIty Addretf i. A <br />(St., Rte. or P.O. ^vAU VaVctAiA VtVHfA <br />City end Zip Code Lt>>\An^ (-dVV» SS'^SA_____ <br />Se^njuJypd (clMCb t^ooe) <br />Q-iTMtrteted Meter <br />Q T Treeted Meter - Treetewnt Type. <br />Q 0 Other <br />Leb ludpet IA<I)4IN 1^1 bl I cI(MI <br />SeepIMp Point Oeicripyon <br />-QeiAfPr".r^vf jX\a csf V\ou^'e <br />AfMljOLT* Type (chick u'one) <br />0T Iflitlel Seeple <br />Q 0 Other <br />Q C Check Seeple <br />Leb Seiple <br />Nuiter <br />OeU <br />Received <br />Oete <br />Confirmed <br />Il7 0l^l5^l7 Field Oleek \hld^|qig <br />2.7> <br />Split Seaple? Q »ei <br />n N 0 0 <br />Oete <br />Raelyied <br />Oete <br />Reported <br />r>.S <br />w i w 0 TT <br />t. KMRIKTU m COKOmUTIflO IMFOUTIflll <br />i^OC'f OittcMT Q Iff 13^0 <br />co4t vgc <br />iCttOllt <br />tthyl fthtr <br />6«nity»t <br />tolutfif <br />CUMAt <br />iHMyltfif <br />tttrihydrofvrin <br />Mtth/1 tihyl kctont <br />atthy1 Isobytyl kttont <br />ethyl btnitnt <br />o-xyltnt <br />p*xylene <br />chloroatthane <br />vinyl chlerlde <br />chloreethtne <br />d Uhl erodi f1 yoroat thine <br />broaoaethine <br />dUh I oref 1 uoroat then# <br />atihyltnt chloride <br />illylchlerlde <br />1.1-dUhleretthine <br />cl !• 1 »2*dUh!eroethy1ene <br />le2-d1chieroethine <br />lolol*trlch1eretthine <br />hfoaedl chi ereaethene <br />2 0 l-dUh1 ore* 1-propene <br />1 f l*df chlore* l*propene <br />lolp2*tr1ch1ereethylent <br />Result (ue/l) <br />% ^ «■ a <br />D L (eoT quwTiruoj <br />teoT oiieeTimDi <br />(JSTJIMXirtQ]. <br />U2Tj|l!QlFiaL <br />£BTJNQl£ial <br />la? JtfRUf'Qi <br />Anelyieo <br />Reouetted <br />Code ^ Result (uo/ll□ m <br />□ [] <br />□ I] <br />□ [] <br />B[| <br />□ [] <br />□ []□ C3 <br />P□ [] <br />□ I] <br />□ [] <br />VOC <br />chlorodibroaoatthine <br />cl$-l,3-d1chloro- <br />1-propene <br />2-ch1oreethylv1nyl ether Q [] ____ <br />1.1.1.2- tetrach1oroethine Q [ ] <br />l.l.2,2*tetrichloroethane Q [j <br />pentachloroethtne <br />1.1.2- trUhlorotrl- <br />fluoreethane <br />1 eZ-dUhlorobenitne <br />trichiorofluoroaethane <br />1 • 1-dUh1oroethy1ene <br />trans-lo2- <br />dichloroeth/ltne <br />chlorofora <br />dibroaoaethane <br />carbon tetrachloride <br />dUhloroacetoni tri 1e <br />1.2*d1ch1oropropane <br />trans*l»3*d1ch1oro* <br />l*propene <br />Io3*d1ch1oropropane <br />l»lp2-tr1ch1oroethane <br />1.2*d1broaoethane <br />broaofora <br />1•2 0 3* tr1 ch1 oropropane <br />R <br />§ <br />San Result (ag/1 unless <br />Paraaeter otherwise noted) <br />nltrate^nltrite nitrogen <L O . ^ Q <br />•aaonia nitrogen _ _ _ JQ <br />chloride <br />*«>'•»• ____L id. <br />Iron _______L 3Z <br />tetrachloroethylene Q c ]_ _ _ _ _•_ _ <br />chlorobenxene Q Q ] <br />1•3-d1chlorobenxene F 1 _ _ _ _ _ _ _ _ _ _ _._ _ _ _ _ <br />1•4-dlchlorobenxene C I 1nn <br />, . □□_ _ _ _._ _ <br />Analyses Result (ag/1 unless <br />Reouested Code Parameter otherwise noted) <br />□□□ <br />specific conductance <br />pH <br />A.2.O._ _umho/cn.