ADEQ Form DWAR20 (WORKSHEET) "Sampling Location Worksheet - Long Term 2 Enhanced Surface Water Treatment Rule (Lt2eswtr)" - Arizona

What Is ADEQ Form DWAR20 (WORKSHEET)?

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, 2014;
  • 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 (WORKSHEET) 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 (WORKSHEET) "Sampling Location Worksheet - Long Term 2 Enhanced Surface Water Treatment Rule (Lt2eswtr)" - Arizona

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Long Term 2
Enhanced Surface Water Treatment Rule
(LT2ESWTR)
Sampling Location Worksheet
(Submit one worksheet for each surface water source intake)
PWS ID Number
PWS Name
Contact Name
Phone Number
E-Mail
1
Treatment Plant Surface Water (TPSW) Number
TPSW Name
1. Name of Water Source
(e.g., Lake Tahoe,
Potomac River, XYZ
Canal)
______________________________________________________
Flowing Stream or Canal
Lake/Reservoir
2. Source Type
GUDI (Ground Water Under the Direct Influence of Surface
Water)
3. Surface Water Source Sampling Intake
Use State assigned number, if applicable _____________________
2
Location ID
Year Round
4. Source Usage
Describe conditions, constraints and months of
Part Year
operation on page 2.
Emergency
5. Proportion of typical average daily flow.
_________________________________________
(Indicate
%)
Return flow location marked on schematic?
6. Recycling Practices
Describe recycling practices on page 2.
Do not recycle backwash
Pretreatment
Bank Filtration
7. Pretreatment Practices
Off-Stream Storage
No pretreatment practices prior to sampling point
None
System applies following chemicals prior to source water treatment:
3
8. Chemical Pretreatment
Copper sulfate or other algaecide / bactericide
Describe locations and chemical pretreatment
Chlorine or potassium permanganate
practices on page 2.
Other chemicals
No chemical addition prior to sampling point
Blended sample tap?
Composite sample? Which sources:___________________
9. Sample Compositing Procedure
Weighted samples value? __________________________
N/A
1
Treatment Plant Surface Water Number: Use the State-issued Facility ID (example: TPSW001), used for reporting on
page 1 of DWAR 15 A & B, or check with regulator.
2
Surface Water Source Sampling Intake Location: Sample Site ID numbers. Use the state-issued sampling point ID
number for this location (example: RW001,etc.), or the system may provide its own identifier.
3
Chemical Pretreatment: Include all chemicals used between the water source and the treatment plant. This may
include, but is not limited to, coagulants, algaecides, oxidants, disinfectants; and recycled filter backwash water.
DWAR 20 (Worksheet)
December 2014
Page 1 of 2
Long Term 2
Enhanced Surface Water Treatment Rule
(LT2ESWTR)
Sampling Location Worksheet
(Submit one worksheet for each surface water source intake)
PWS ID Number
PWS Name
Contact Name
Phone Number
E-Mail
1
Treatment Plant Surface Water (TPSW) Number
TPSW Name
1. Name of Water Source
(e.g., Lake Tahoe,
Potomac River, XYZ
Canal)
______________________________________________________
Flowing Stream or Canal
Lake/Reservoir
2. Source Type
GUDI (Ground Water Under the Direct Influence of Surface
Water)
3. Surface Water Source Sampling Intake
Use State assigned number, if applicable _____________________
2
Location ID
Year Round
4. Source Usage
Describe conditions, constraints and months of
Part Year
operation on page 2.
Emergency
5. Proportion of typical average daily flow.
_________________________________________
(Indicate
%)
Return flow location marked on schematic?
6. Recycling Practices
Describe recycling practices on page 2.
Do not recycle backwash
Pretreatment
Bank Filtration
7. Pretreatment Practices
Off-Stream Storage
No pretreatment practices prior to sampling point
None
System applies following chemicals prior to source water treatment:
3
8. Chemical Pretreatment
Copper sulfate or other algaecide / bactericide
Describe locations and chemical pretreatment
Chlorine or potassium permanganate
practices on page 2.
Other chemicals
No chemical addition prior to sampling point
Blended sample tap?
Composite sample? Which sources:___________________
9. Sample Compositing Procedure
Weighted samples value? __________________________
N/A
1
Treatment Plant Surface Water Number: Use the State-issued Facility ID (example: TPSW001), used for reporting on
page 1 of DWAR 15 A & B, or check with regulator.
2
Surface Water Source Sampling Intake Location: Sample Site ID numbers. Use the state-issued sampling point ID
number for this location (example: RW001,etc.), or the system may provide its own identifier.
3
Chemical Pretreatment: Include all chemicals used between the water source and the treatment plant. This may
include, but is not limited to, coagulants, algaecides, oxidants, disinfectants; and recycled filter backwash water.
DWAR 20 (Worksheet)
December 2014
Page 1 of 2
Long Term 2
Enhanced Surface Water Treatment Rule
(LT2ESWTR)
Sampling Location Worksheet
(Submit one worksheet for each surface water source intake)
PWS ID Number
PWS Name
TPSW Number
TPSW Name
1. Source Usage Describe conditions, constraints and months of operation:
2. Recycling Practices Describe all filter backwashing recycling practices:
3 -
3. Chemical Pretreatment
Indicate the location of any chemical pretreatment on plant schematic and provide a full
description of chemical addition practices below, specifically:
Systems using copper sulfate or another algaecide or bactericide in the system’s reservoirs, specify the dates
that copper sulfate has already been applied, and the dates proposed to apply copper sulfate.
Systems feeding chlorine or potassium permanganate at the intake, explain how this will be accomplished.
Systems using any other chemical(s), provide details on any other chemical(s) added to the raw water, or the
source.
IMPORTANT NOTE: Do not discontinue the use of any chemical, if this could have an adverse effect or present a risk to
health. If unsure, please contact ADEQ or MCESD before discontinuing any chemical usage.
4. Additional Information - Include any additional information that ADEQ or MCESD (if MCESD regulated) should
consider when evaluating the monitoring location(s) here, or as an attachment.
Submit the completed form to the system’s regulatory agency:
LT2 Rule Specialist
Manager
Drinking Water Monitoring and Protection Unit
Safe Drinking Water Program
Arizona Department of Environmental Quality
Maricopa County Environmental Services Department
1110 W. Washington St., Mail Code 5415 B-2
1001 N Central Avenue, Suite 250
Phoenix, AZ 85007
Phoenix, AZ 85004
Fax: 602-771-4634
Desk: 602.506.6935 | Fax: 602.372.0866
lt2rule@azdeq.gov
sdwquestions@mail.maricopa.gov
DWAR 20 (Worksheet)
December 2014
Page 2 of 2
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