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MINNESOTA DEPARTMENT OF NEALTH I 6ROUND-�iATER MONITORIN6 - YOC SAMPLE/ANALYSIS REPORT <br /> ' Form SSU-3 Rev. 9-85 <br /> S. SAIOLE INFOAIMTION <br /> Site I.D. Field Yell �` Mater Systa� <br /> N�e� Z — C7 S N�aber ("t S Naa�e (Publit Syste�) <br /> Collection Ti�e Owner Na�e ��(� t��n W� <br /> Oate 7 (2�-h�. clock) � Fatility Addross <br /> N M D D r r H H M M <br /> (St., Rte. or P.O. Box) 3��(1 �h (� <br /> Collected by o�M City and Zip Code �A S3 <br /> S+aP� TpPe (check v one) Lab Qudget I�I�I I,I I,..�I' IUI I�I,,J <br /> �-n Untreated Mater Nuibtr c} INB <br /> (] T Treated Mater-Treataient Type up ��e � Fi�rBlank U O i I <br /> ❑ 0 Other Nu�ber <br /> Sampi ng Point Description �� �� <br /> u du� S � � �U uLi Recei ved Ma l yzed 6 Z U <br /> M M 0 0 Y Y M M D D Y Y <br /> Malysis Tjrpe (check vone) <br /> [t�t�Initial Sample � C Check Sample Date Dste <br /> ❑ 0 Other Confi nieG Reported Q <br /> Split 5 M M o o r r N N n o r r <br /> ample7 � Yes [�Fo <br /> 6. PARAlETER AND CONCENTRATION INFORINTION <br /> e a <br /> Ilnalysis Requested - Yolatile N rocarbon - Code 465 ���`'�``f <br /> Code VOC y� d� Result (ug/1) <br /> �OC's Detected? � lres No a — _ — — — — <br /> chtorodibromomethane <br /> cis-1,3-dichloro- <br /> .�`'�`.!�'� 1-propene ❑ — — — — — — <br /> Code VOC er d Result (u9/1) 2-chloroethylvinyl ether � _ _ _ _ _ _ <br /> acetone � _ _ _ _ _ _ 1.1,1,2-tetrachloroetha�e ❑ _ _ _ _ _ _ <br /> ethyl ether � 1.1.2,2-tetrachloroethane � _ _ _ _ _ _ <br /> benzene � _ _ _ _ _ _ pentachloroethane ❑ _ _ _ _ _ _ <br /> toluene � _ _ _ _� 1,1,2-trichlorotri- <br /> � _ _ _ _ _ _ fluoroethane � <br /> ���e 1.2-dichlorobenzene � <br /> m-zylene ❑ _ _ _ _ _ _ trichiorofluoromethane � <br /> tetrahydrofuran ❑ _ _ _ _ _ _ 1,1-dichtoroethylene � <br /> methyl ethyl ketone ❑ __ _ _ _ _ trans-l.2- <br /> methyl isobutyl ketone [� _ _ _ _. ._ dichloroethylene � <br /> ethyl De�zene ❑ _ _ _ _ _ _ chloroforni � <br /> o-xylene ❑ _ _ _ _ _ _ dibromomethane � <br /> p-xytene ❑ _ _ carbon tetrachloride � <br /> chlorometh�ne � �r�wulTtFtE�._ _ dichloroacetonitrile � <br /> vinyl chtoride � �T,�TiFt1._ _ 1,2-dichloropropane � <br /> chloroethane � �T�u�Ttvt�._ _ trans-l.3-dichloro- <br /> dichlorodifluoromethane � LT UANTIFIW�._ _ 1-propene � <br /> bromomethane � LT lIAMTIfI�._ _ 1.3-dichloropropane � <br /> dichlorofluoromethane � L IIANTIFi1._ _ 1.1.2-trichloroethane � <br /> methYlene chloride � _ _ _ _ _ _ 1,2-dibroaaethane � <br /> a11ylch1or1Ge ❑ _ _ _ _ _ _ bromoform � <br /> 1.1-dichloroethane ❑ _ _ _ _ _ _ 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 /> braoodlchloromethane � _ _ _ _ _ _ 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/1 unless Analyses Result (mg/1 unless <br /> RequesteG Code Parameter otherwise noted Requested Code Parameter otherwise notea) <br /> � nitrate+nitrite nitrogen � _ �. � specific conductance _ � Q <br /> ❑ ammonia nitrogen _ �._Z Wnho/cm. <br /> � chloride _ _ �, �Q Q pH — Z ,Z <br /> ❑ suifate _ Z Z, _ _ __ _ _ <br /> � iron — — � ' � � � — - - - -- <br />