ADEQ Form DWAR20 "Drinking Water Analysis Reporting Form - Long Term 2 Enhanced Surface Water Treatment Rule (Lt2eswtr) - Reporting Form for Schedule 4 Systems Monitoring for Cryptosporidium" - Arizona

What Is ADEQ Form DWAR20?

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 September 1, 2018;
  • 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 DWAR20 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 DWAR20 "Drinking Water Analysis Reporting Form - Long Term 2 Enhanced Surface Water Treatment Rule (Lt2eswtr) - Reporting Form for Schedule 4 Systems Monitoring for Cryptosporidium" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
Long Term 2 Enhanced Surface Water Treatment Rule (LT2ESWTR)
Reporting Form for Schedule 4 Systems monitoring for Cryptosporidium
*** ONE SAMPLE SET PER FORM ***
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
SAMPLE LOCATION
MONITORING PERIOD
MONTH [___________]
Surface Water Intake ID [___________]
YEAR [_____________]
Intake Name [_________________________________]
Plant operated entire monitoring period and sampled outside of 5 day window.◊
Plant operated entire monitoring period and sampled according to schedule.
Plant operated partial monitoring period and sampled outside of 5 day window.◊
Plant operated partial monitoring period and sampled according to schedule.
Plant did not operate any day of this monitoring period due to normal events.*
Plant did not operate any day of this monitoring period due to unusual events.**
◊ Must notify ADEQ or MCESD when sending LT2ESWTR (LT2) sampling to laboratory.
* LT2 samples not required.
** LT2 sampling required if source is available.
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Laboratory Analysis Results for Cryptosporidium (if 40 CFR § 141.706 (1) (ii) and/or (iii) applies, enter in comments section)
Sample
Sample Type
Analysis Run
Volume
# of
100% Volume or %
Method
# of
Matrix Spike
Specimen Number
Lab ID
Date
Time
Field
Matrix
Date
Time
Filtered to
Oocysts
Examined
Number
Oocysts
Oocysts Spiked
nearest ¼ L
per Liter
Spike
Yes
or ____%
Yes
or ____%
I hereby certify that the information provided in this report is accurate and correct to the best of my knowledge:
Lab ID Number [AZ________]
Lab Name [________________________________]
Phone Number [______________________]
Lab Contact, Printed Name [______________________________]
Authorized Signature [____________________________________]
Comments [___________________________________________________________________________________________________________]
PWS Notification Date [___________________________]
PWS Person Notified [_____________________________________________]
Submit 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 20: Revised 9/2018
DRINKING WATER ANALYSIS REPORTING FORM
Long Term 2 Enhanced Surface Water Treatment Rule (LT2ESWTR)
Reporting Form for Schedule 4 Systems monitoring for Cryptosporidium
*** ONE SAMPLE SET PER FORM ***
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
SAMPLE LOCATION
MONITORING PERIOD
MONTH [___________]
Surface Water Intake ID [___________]
YEAR [_____________]
Intake Name [_________________________________]
Plant operated entire monitoring period and sampled outside of 5 day window.◊
Plant operated entire monitoring period and sampled according to schedule.
Plant operated partial monitoring period and sampled outside of 5 day window.◊
Plant operated partial monitoring period and sampled according to schedule.
Plant did not operate any day of this monitoring period due to normal events.*
Plant did not operate any day of this monitoring period due to unusual events.**
◊ Must notify ADEQ or MCESD when sending LT2ESWTR (LT2) sampling to laboratory.
* LT2 samples not required.
** LT2 sampling required if source is available.
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Laboratory Analysis Results for Cryptosporidium (if 40 CFR § 141.706 (1) (ii) and/or (iii) applies, enter in comments section)
Sample
Sample Type
Analysis Run
Volume
# of
100% Volume or %
Method
# of
Matrix Spike
Specimen Number
Lab ID
Date
Time
Field
Matrix
Date
Time
Filtered to
Oocysts
Examined
Number
Oocysts
Oocysts Spiked
nearest ¼ L
per Liter
Spike
Yes
or ____%
Yes
or ____%
I hereby certify that the information provided in this report is accurate and correct to the best of my knowledge:
Lab ID Number [AZ________]
Lab Name [________________________________]
Phone Number [______________________]
Lab Contact, Printed Name [______________________________]
Authorized Signature [____________________________________]
Comments [___________________________________________________________________________________________________________]
PWS Notification Date [___________________________]
PWS Person Notified [_____________________________________________]
Submit 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 20: Revised 9/2018