ADEQ Form DWAR19 "Initial Start-Up Monitoring Form for Ground Water Systems With Treatment Plants and/Or Blending Plans" - Arizona

What Is ADEQ Form DWAR19?

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 May 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 DWAR19 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 DWAR19 "Initial Start-Up Monitoring Form for Ground Water Systems With Treatment Plants and/Or Blending Plans" - Arizona

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Please mail completed form and all Field & Lab
Initial Start-Up Monitoring Form
analyses to:
For Ground Water Systems with
ADEQ Drinking Water Monitoring and Protection Unit
Treatment Plants and/or Blending Plans
1110 W. Washington St., Mail Code 5415B-2,
Phoenix, AZ 85007
or Fax to: 602-771-4634
AZ04 –
PWS ID Number
(5
digits):
PWS Name:
Contact Person/Title:
Phone #
E-Mail Address:
Choose One:
Treatment Plant Only
Treatment Plant & Blending Plan
Blending Plan Only
Arsenic
Fluoride
Nitrate
Other:
Entry Point to the Distribution System (EPDS) #:
Contaminant:
Finished
Raw Water Result (mg/L)
(Insert well registration numbers below)
Treated
Sample
Blended
Water
Well #
Well #
Well #
Well #
Well #
Samples
MM/DD/YY
Time
Water
Test Method
Result
55-
55-
55-
55-
55-
(24h)
Results
(mg/L)
(mg/L)
Day 1
Field
Lab
Day 2
Field
Lab
Day 3
Field
Lab
Day 4
Field
Lab
Day 5
Field
Lab
Week 2
Lab
Week 3
Lab
Week 4
Lab
Month 2
Lab
Month 3
Lab
If Water System chooses to take Field Tested Water Samples, any of the following Field Test Kits are acceptable:
ITS Arsenic Quick II Test Kit, Pat
All Water Samples from week
No. 481303, ITS Fluoride eXact Xtra Micro Strips, Part No. 486611 or Hach Nitrate Color Disc Test Kit Model NI-14.
2 thru Month 3 must be submitted to a Certified Laboratory for analysis. Hard copies of Certified Lab Results must be provided with this form.
I hereby certify that the information listed above is accurate to the best of my knowledge. Furthermore, unless otherwise directed by the State, I
understand that quarterly compliance monitoring shall commence for the above noted contaminant after initial monitoring has been completed. This
quarterly routine compliance monitoring frequency shall remain in effect for the life of the treatment plant.
Water System Owner/Representative (Print)
Signature
Date
DWAR 19
May 2014
Please mail completed form and all Field & Lab
Initial Start-Up Monitoring Form
analyses to:
For Ground Water Systems with
ADEQ Drinking Water Monitoring and Protection Unit
Treatment Plants and/or Blending Plans
1110 W. Washington St., Mail Code 5415B-2,
Phoenix, AZ 85007
or Fax to: 602-771-4634
AZ04 –
PWS ID Number
(5
digits):
PWS Name:
Contact Person/Title:
Phone #
E-Mail Address:
Choose One:
Treatment Plant Only
Treatment Plant & Blending Plan
Blending Plan Only
Arsenic
Fluoride
Nitrate
Other:
Entry Point to the Distribution System (EPDS) #:
Contaminant:
Finished
Raw Water Result (mg/L)
(Insert well registration numbers below)
Treated
Sample
Blended
Water
Well #
Well #
Well #
Well #
Well #
Samples
MM/DD/YY
Time
Water
Test Method
Result
55-
55-
55-
55-
55-
(24h)
Results
(mg/L)
(mg/L)
Day 1
Field
Lab
Day 2
Field
Lab
Day 3
Field
Lab
Day 4
Field
Lab
Day 5
Field
Lab
Week 2
Lab
Week 3
Lab
Week 4
Lab
Month 2
Lab
Month 3
Lab
If Water System chooses to take Field Tested Water Samples, any of the following Field Test Kits are acceptable:
ITS Arsenic Quick II Test Kit, Pat
All Water Samples from week
No. 481303, ITS Fluoride eXact Xtra Micro Strips, Part No. 486611 or Hach Nitrate Color Disc Test Kit Model NI-14.
2 thru Month 3 must be submitted to a Certified Laboratory for analysis. Hard copies of Certified Lab Results must be provided with this form.
I hereby certify that the information listed above is accurate to the best of my knowledge. Furthermore, unless otherwise directed by the State, I
understand that quarterly compliance monitoring shall commence for the above noted contaminant after initial monitoring has been completed. This
quarterly routine compliance monitoring frequency shall remain in effect for the life of the treatment plant.
Water System Owner/Representative (Print)
Signature
Date
DWAR 19
May 2014