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Lead in Drinking Water - School and Child Care Center Reporting Template
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This spreadsheet is for Minnesota child care centers, public and charter schools to report lead in drinking water results and remediation actions to the Minnesota Department of Health (MDH)
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Please complete the spreadsheet to the best of your ability. One spreadsheet per building. MDH staff may reach out to the contact person if there are questions.
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Directions for this template can be found at Results Reporting Instructions and FAQ (PDF).
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Facility or Building NameAdrian Elementary SchoolSummarySUMMARYANSWER
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Blank cellsTotal number of samples16
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Did the facility test using the MDH testing program (WIIN)? (Yes or No)NoTotal number of fixtures sampled16
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Blank cellsTotal number of results above 5 ppb1
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Facility Type (School or Child Care)SchoolTotal number of remediation actions1
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Next Scheduled Sampling Date (Month/Year)
Sep-28
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School ID Number or Child Care License Number
0511-01-010
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Facility or Building Address515 Oklahoma Ave, Adrian, MN 56110
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Mailing Address515 Oklahoma Ave, Adrian, MN 56110
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Contact PersonMolly Schilling
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TitleSuperintendent
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Phone507-827-0904
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Emailm.schilling@isd511.net
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Lead Related Website (if applicable-required for schools)
https://www.isd511.net/
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Date submitted to MDH (to be completed by MDH staff)
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Minnesota Department of Health
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Email MDH Lead Results Reporting (Lead.Results.Reporting.MDH@state.mn.us)
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To obtain this information in a different format, call 651-201-4700.
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