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r orm JJUU-o, ltev. 5•t34 <br /> • <br /> Water System ,/ / S �� <br /> .9 / .3 .0 IJ '- 44 D Name 01-12-114C-A-SZ--. <br /> a l-01'1 L1 KCJ1ll4e-K <br /> - <br /> ; P.O. ci/ Municipality <br /> f-- . County l/Ci1 VL <br /> Sample Source Address <br /> ;ion -7 �-. <br /> M(� D fey (or)WellNo.--- <br /> Descr Sampling Point 1?) <br /> Description _ 7 <br /> Time _ O. O <br /> / (24 Hr.Clock) H H M Field No. -- <br /> Water System Type(check r one) <br /> 1 Sepdort Address - � t ❑ M Community- Municipal <br /> To: 3°1[ l Cj-3It v- r 1-4-i.-1 e ❑ O Community- Other Than Municipal <br /> City,Spike,Zip Code 1 0 N Non-Community <br /> i�T-C--E-N-` ` XP Private ❑X Non-Potable Well <br /> a le Type(check ✓ one) <br /> Collected By D Distribution Sample <br /> a <br /> Account 0 3 0 W Raw Water <br /> Number V <br /> For Lab Use Only A yeas Type(check ✓ one) <br /> Detection Limits(ug/1)are �bt I GC/MS Screening <br /> indicated in brackets[] %A 'Ic'rtea (ugn) O Confirmation of GC/MS <br /> ❑ 007 Acrolein[50J p ❑ ---•- Screening Sample Number(fill in) <br /> ❑ Other(Follow Up, Misc. <br /> ❑ 009 Acrylonitrile[20J ❑ ❑ ---•- pet•r�pe o n <br /> ug <br /> O 025 Benzene[1.0] <br /> 0 ❑ --- •- 0 183 cis-1,3-Dichloropropene(2.5) 0 7 --- •- <br /> ❑ 046 Bromobenzene14.Oj ❑ ❑ ---•- 0 185 trans-1,3-Dichloropropene[2.5). 0 11 ---•_____ <br /> ❑ 051 Bromodichloromethane[1.5) 0 G --- •- ❑ 233 Ethylbenzene(1.0] 0 I --•- <br /> O 053 Bromoform[5.0] <br /> 0 0 --- • <br /> ❑ 427 Fluorotrichloromethane(1.0] O ---•- <br /> O 055 Bromomethane[50] C ❑ ---•- <br /> `, 298 Isopropylbenzene[1.0] 0 I ---•- <br /> O-063 n-Butylacetate[0.5] C ❑ --- •- <br /> C 319 Methylethylketone(MEK1[12J ❑ I ---•- <br /> O 071 Carbon Disulfide[5.0] ❑ ❑ ---•- <br /> O 393 Styrene[2.0] ❑ 1 ---•- <br /> O 073 Carbon Tetrachloride[1.5] ❑ 0 ---•- <br /> O 396 1,1,1,2-Tetrachloroethane[3.0) ❑ 1 _____--•- <br /> O 083 Chlorobenzene[2.0) O ❑ ---•- <br /> O 397 1,1,2.2-Tetrachloroethane[3.0j ❑ 1 ---•_❑ 087 Chloroethane[20) 0 ❑ ---•_ ❑ 399 Tetrachloroethylene[1.0] 0 1 ---• <br /> O 093 2-Chloroethylvinyl Ether[4.0) 0 ❑ ---•__ <br /> ❑ 401 Tetrahydrofuran(THF1[200] 0 I ---•- <br /> O 095 Chloroform[1.0] ❑ ❑ ---•__ <br /> ❑ 411 Toluene[1.0J 0 i1 -•- <br /> ❑ 108 o-Chlorotoluene[1.0] 0 ❑ - •- <br /> -- <br /> ❑ 421 1,1,1-Trichloroethane[1.0J 0 1 --•- <br /> ❑ 110 p-Chlorotoluene[1.0) ❑ 0 - •- <br /> --• -' <br /> ❑ 423 1,1,2-Trichloroethane[1.5] O • <br /> 0 147 Dibromochloromethane[2.0) 0 0 ---•- --- - <br /> 0 148 1,2 Dibromo-3 Chloropropane 0 ❑ [not quantified] - 0 425 Trichloroethylene[1.0) 0 -- •- <br /> O 428 Trichlorotrifluoroethane[3.01 0 t ___•_ <br /> 0 153 o-Dichlorobenzene[2.0] 0 0 ---•- ❑ <br /> [not quantified] <br /> ❑ 434 Vinyl Chloride 1 --- � <br /> - <br /> O 156 m-Dichlorobenzene(2.0) ❑ Ii ---•- <br /> O 437 Xylenes[2.0] 0 I ---•- <br /> 0 157 p-Dichlorobenzene[2.0) ❑ C ---•- O ❑ ---•-❑ 165 1,1-Dichlorcethane[1.0] 0 0 - •- <br /> • O 167 1,2-Dichloroethane[1.0] ❑ O ---•- 1. ❑ �������' �����, '� ❑ --- •- <br /> O 169 1,1-Dichloroethylene[1.0j 0 0 --- •- Comments <br /> O 171 1,2-Dichloroethylene(1.0] ❑ O ---•- a - ! 4"z '':"': <br /> ❑ 174 Dichloroiodomethane ❑ 0 [not quantified) r i JU1 1085 <br /> --- Date Received .}:, <br /> ❑ 181 1,2 Dichloropropane[1.0) ❑ [, ---• and Sample No ''- .'`snmh ' ;" 2 _ �}� <br /> R.H. Laessig, PhD, Director <br /> • Date Reported _Dm L �1 I�J.J <br /> Wisconsin State Laboratory of Hygiene 77 5�++��� <br /> Madison, Wisconsin 53706 O�JV� �!2,_1�f>4- /k)7G sCf4c./ <br />