ADEQ Form DWAR08 "Drinking Water Analysis Reporting Form - Lead and Copper" - Arizona

What Is ADEQ Form DWAR08?

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 DWAR08 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 DWAR08 "Drinking Water Analysis Reporting Form - Lead and Copper" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
LEAD AND COPPER
***
PUBLIC WATER SYSTEM INFORMATION
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
PWS ID Number: AZ04 __________________
PWS Name: _________________________________________________________
________________________________
(_____)________________________
______________________________
Owner/Contact Person
Owner/Contact Phone Number
Owner/Contact Email Address
Contaminant:
Lead (Pb)
Copper (Cu)
SAMPLE TYPE:
Action Level:
Distribution Tap Monitoring
0.015 mg/L
1.3 mg/L
Source Water Sample [EPDS: ___________]
Analysis Method:
________________
________________
Special Purpose Sample for state information only (NOT FOR COMPLIANCE)
*** LEAD AND COPPER ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Lead mg/L
Analysis
Copper mg/L
Collection Point
Completion
(1030)
Completion
Specimen #
or
Sample Date
(1022)
Date
Result
Date
EPDS #
Result
90th % Calc:
_____________
____________
I hereby certify that the information provided in this report is accurate and correct to the best of my k nowledge:
Lab ID Number [AZ________]
Lab Name [________________________________]
Phone Number [______________________]
Lab Contact, Printed Name [______________________________]
Authorized Signature [____________________________________]
Comments [_________________________________________________________________________________________________________]
PWS Notification Date [_________________________]
PWS Person Notified [_____________________________________________]
Subm it completed form to: EMAIL:
WQD_Compliance_Data@azdeq.gov
-or- MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
or questions call: (602) 771-9200
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 08: Rev ised 12/2017
DRINKING WATER ANALYSIS REPORTING FORM
LEAD AND COPPER
***
PUBLIC WATER SYSTEM INFORMATION
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
PWS ID Number: AZ04 __________________
PWS Name: _________________________________________________________
________________________________
(_____)________________________
______________________________
Owner/Contact Person
Owner/Contact Phone Number
Owner/Contact Email Address
Contaminant:
Lead (Pb)
Copper (Cu)
SAMPLE TYPE:
Action Level:
Distribution Tap Monitoring
0.015 mg/L
1.3 mg/L
Source Water Sample [EPDS: ___________]
Analysis Method:
________________
________________
Special Purpose Sample for state information only (NOT FOR COMPLIANCE)
*** LEAD AND COPPER ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Lead mg/L
Analysis
Copper mg/L
Collection Point
Completion
(1030)
Completion
Specimen #
or
Sample Date
(1022)
Date
Result
Date
EPDS #
Result
90th % Calc:
_____________
____________
I hereby certify that the information provided in this report is accurate and correct to the best of my k nowledge:
Lab ID Number [AZ________]
Lab Name [________________________________]
Phone Number [______________________]
Lab Contact, Printed Name [______________________________]
Authorized Signature [____________________________________]
Comments [_________________________________________________________________________________________________________]
PWS Notification Date [_________________________]
PWS Person Notified [_____________________________________________]
Subm it completed form to: EMAIL:
WQD_Compliance_Data@azdeq.gov
-or- MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
or questions call: (602) 771-9200
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 08: Rev ised 12/2017