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MINNESOTA DEPARTMENT OF HEALTH 6ROUN0-MIATER MONITORIN6 - YOC SAMPLE/ANALYSIS REPORT <br /> Form SSU-3 Rev. 9-85 <br /> S. SAIPLE INFOAlNTION <br /> SN�'.0. Z U S � Ni�rMell Mater Syste� <br /> .S � Nase (Public Syste+�) <br /> Collectloe T1�e Orner Na�e t—I c��[� ��AScL► �Wl <br /> pate 7 (2�-hr. tlock) � Facilit Address '1 <br /> M M D D r r H H M M Y <br /> (SL., Rte. or P.O. Box)_f� �C\ Fi� u V�G� � <br /> �»«� py a � City and Zip Code S S 3 5 <br /> [.�'G Untreated Hakter�, Nu�ber �t I I'VU��F��� �GI.� Il�� ��--��I <br /> � T Treated Nater-Treataient Type Lab Sa�aple Field Blank i <br /> � 0 Other Nunber 7 � �3 Nu�ber O � �/I <br /> Saapling P int scri tion 1 �(` <br /> C�N�S��Z ��ut� � eO�S� Sll`e o`r �o�l1P Oate Date <br /> QT Received � Malyzed Z $ <br /> M M 0 0 Y Y M M D 0 Y Y <br /> Malysis Type (check v one) <br /> [��Initial Sample ❑ C Check Sample �� �� <br /> ❑ 0 Otber Confinoed Reported � 6 � <br /> M M D D Y Y M M 0 D Y Y <br /> Split Sample? � Yes [�►f6' <br /> 6. PARAIETER AND CONCENTRATION INFOWNTION � <br /> .f° �° <br /> alysis Requested - Volatile Hyd carbon - Code 465 Code VOC �``��M`6� Result (ug/1) ; <br /> �OC's Detected7 ❑ ves No a a — — — — — — <br /> chlorodibromomethane <br /> cis-1,3-dichloro- <br /> �°� �t° 1-propene ❑ ❑ _ _ _ _•_ _ <br /> Code VOC d`� �d'� Result (u9/1) 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 /> fluoroethane <br /> cumene ❑ ❑ _ _ _ _ — — 1.2-dichlorobenzene ❑ ❑ _ � <br /> m-xytene ❑ ❑ — — — — — — — — — — — <br /> tetrahydrofuran � � � _ trichlorofluoromethane � � <br /> 1,1-dichloroethylene � � _ ;i <br /> methyl ethyl ketone ❑ ❑ _ _ _ _ _ _ — — — — — ! <br /> methyl isobutyl ketone ❑ ❑ _ _ _ _ _ _ trdichloroethylene � � _ I <br /> ethyl benzene ❑ ❑ _ chloroform � � _ _ _ _ _ _ <br /> o-xylene D Q = _ _ _ _ _ dibromomethane _ _ _ _ _ I <br /> p-xylene _ _ _._ � <br /> — carbon tetrachloride � � _ <br /> chloromethane � � NaT�lIANTIFIE�._ _ dichloroacetonitrile � � _ <br /> vinyl chloride � � jNOT�rtFtE�._ _ 1,2-dichioropropane � � _ <br /> chloroethane � � MaT uAMTiFIE�._ _ trans-1,3-dichloro- <br /> dichlorodifluoranethane � � NOT�IIANTIFIEO ._ _ 1-propene � � _ _ _ _ _ _ <br /> bromomethane � � NOT�u�TIVIEo ._ _ 1.3-Cichioropropane � � _ _ _ _ _ _ <br /> dichlorofluoromethane � � NOT 11ANTIFIE�._ _ 1.1,2-trichloroethane <br /> methylene chloride ❑ ❑ _ _ _ _ _ _ 1.2-dibromoethane � ❑ _ _ _ _ _ _ <br /> ailylchloride ❑ ❑ _ _ _ _ _ _ bromoform <br /> 1.1-dichloroethane ❑ ❑ • <br /> _ — _ _•_ — 1.2.3-trichloropropane � � _ _ _ _ . _ _ <br /> cis-l.2-dichloroethylene [] ❑ _ _ _ _ _ _ 1.1.2�2- <br /> 1�2-dichloroethane � ❑ _ _ _ _ _ _ tetrachloroethylene � � _ _ _ _ _ _ <br /> 1.1.1-trichloroethane ❑ ❑ _ _ _ _._ _ chlorobenzene � � <br /> - - - -'- - <br /> bromodichloranethane ❑ ❑ _ _ _ _._ _ 1.3-dichlorobenzene ❑ ❑ <br /> 2.3-4lchloro-l-propene � � _ _ _ _ _ _ 1,4-dichlorobenzene � � _ _ _ _ _ _ <br /> 1.1-dichloro-l-propene ❑ ❑ _ _ _ _ _ _ � � _ _ _ _ _ _ <br /> 1.1.2-trithloroethylene [] ❑ ❑ ❑ <br /> Analyses Result (mg/1 unless Analyses Result (mg/1 unless <br /> �eQuested Code Parameter otherNise noteC ReGuested Code Parameter otherwise noted) <br /> � nitrate;nitrite nitrogen � _ C . � specific conductance _ � _ Q. _ _ <br /> a ammonia nitrogen — _ _ C_, . ;� � umh cm. <br /> chloride (`: . ��> � ❑ pH — Z . � <br /> � sulfate _ _ � c'_. _ _ � - - -- - - <br /> � iron _ _ i . �- _ � - - -- -- <br />