ADEQ Form DWAR2B "Drinking Water Analysis Reporting Form - Asbestos" - Arizona

What Is ADEQ Form DWAR2B?

This is a legal form that was released by the Arizona Department of Environmental Quality - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Arizona Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of ADEQ Form DWAR2B by clicking the link below or browse more documents and templates provided by the Arizona Department of Environmental Quality.

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Download ADEQ Form DWAR2B "Drinking Water Analysis Reporting Form - Asbestos" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
ASBESTOS
* Distribution System or Entry Point to the Distribution System (EPDS) Only *
D
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
[_____:________]
________________________________________________
Sample Date
Sample Time
Owner/Contact Person
(24HR CLOCK)
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SAMPLE TYPE
For MCL or Composite Level Sample Exceedance
Compliance Monitoring
[___________________]
Original Violation Specimen Number
SAMPLE COLLECTION POINT
SAMPLE TYPE
Entry Point to the Distribution System [EPDS _____ ]
- or -
Confirmation
Confirmation Composite
Distribution System [Site ID __________________ ]
*** ASBESTOS ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Exceeds
MCL
Result *
Method
Limit
Name
Code
Run Date
MCL
Reporting Limit
7 MFL
0.2
Asbestos
1094
*** LABORATORY INFORMATION ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
[________________________]
Specimen Number
Comment [___________________________________________]
Lab ID Number [AZ________]
Lab Name [_______________________]
Phone Number [_________________]
Lab Contact, Printed Name [___________________]
Authorized Signature [________________________________]
PWS Notification Date [_______________]
PWS Person Notified [_____________________________________]
*
All units must be reported in
Subm it completed form to:
million fibers per liter (MFL)
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or- MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
For questions call: (602) 771-9200
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 2B: Revised 12/2017
DRINKING WATER ANALYSIS REPORTING FORM
ASBESTOS
* Distribution System or Entry Point to the Distribution System (EPDS) Only *
D
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
[_____:________]
________________________________________________
Sample Date
Sample Time
Owner/Contact Person
(24HR CLOCK)
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SAMPLE TYPE
For MCL or Composite Level Sample Exceedance
Compliance Monitoring
[___________________]
Original Violation Specimen Number
SAMPLE COLLECTION POINT
SAMPLE TYPE
Entry Point to the Distribution System [EPDS _____ ]
- or -
Confirmation
Confirmation Composite
Distribution System [Site ID __________________ ]
*** ASBESTOS ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Exceeds
MCL
Result *
Method
Limit
Name
Code
Run Date
MCL
Reporting Limit
7 MFL
0.2
Asbestos
1094
*** LABORATORY INFORMATION ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
[________________________]
Specimen Number
Comment [___________________________________________]
Lab ID Number [AZ________]
Lab Name [_______________________]
Phone Number [_________________]
Lab Contact, Printed Name [___________________]
Authorized Signature [________________________________]
PWS Notification Date [_______________]
PWS Person Notified [_____________________________________]
*
All units must be reported in
Subm it completed form to:
million fibers per liter (MFL)
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or- MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
For questions call: (602) 771-9200
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 2B: Revised 12/2017