ADEQ Form DWAR1S "Drinking Water Analysis Reporting Form - Microbiological/Revised Total Coliform Rule" - Arizona

What Is ADEQ Form DWAR1S?

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 DWAR1S 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 DWAR1S "Drinking Water Analysis Reporting Form - Microbiological/Revised Total Coliform Rule" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
MICROBIOLOGICAL/REVISED TOTAL COLIFORM RULE
Monthly summary reporting for systems with 6 or more Routine samples
*** Distribution System Only ***
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
________________________________________________
Report Date
Owner/Contact Person
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SUBMIT ONE SUMMARY FORM PER SYSTEM, PER MONITORING PERIOD.
Monitoring Period
Month [_______________] Year [_______________]
*** MICROBIOLOGICAL (ANALYTE 3100) ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
[_______________]
[_______________]
Number of Routine Samples
Number of Routine Negatives
PLEASE ATTACH LIST OF LOCATION ID AND ASSOCIATED SAMPLE DATES
Include: Location ID/Sample Site, Sample Date/Time, Specimen ID, Analysis Method, Analysis Start and Complete Date/Time, Analysis Result
Have any Positive Routine Samples or any Repeat Samples been filled out using DWAR-1R and sent in?
(If applicable)
YES
NO
N/A
Have any GWR Samples been filled out using DWAR-1GR and sent in?
(If applicable)
YES
NO
N/A
*** 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 [_____________________________________]
PLEASE DO NOT SUBMIT
Submit completed form to:
MULTIPLE TIMES
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 1S: Revised 12/2017
DRINKING WATER ANALYSIS REPORTING FORM
MICROBIOLOGICAL/REVISED TOTAL COLIFORM RULE
Monthly summary reporting for systems with 6 or more Routine samples
*** Distribution System Only ***
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
________________________________________________
Report Date
Owner/Contact Person
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SUBMIT ONE SUMMARY FORM PER SYSTEM, PER MONITORING PERIOD.
Monitoring Period
Month [_______________] Year [_______________]
*** MICROBIOLOGICAL (ANALYTE 3100) ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
[_______________]
[_______________]
Number of Routine Samples
Number of Routine Negatives
PLEASE ATTACH LIST OF LOCATION ID AND ASSOCIATED SAMPLE DATES
Include: Location ID/Sample Site, Sample Date/Time, Specimen ID, Analysis Method, Analysis Start and Complete Date/Time, Analysis Result
Have any Positive Routine Samples or any Repeat Samples been filled out using DWAR-1R and sent in?
(If applicable)
YES
NO
N/A
Have any GWR Samples been filled out using DWAR-1GR and sent in?
(If applicable)
YES
NO
N/A
*** 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 [_____________________________________]
PLEASE DO NOT SUBMIT
Submit completed form to:
MULTIPLE TIMES
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 1S: Revised 12/2017