Form DWAR10 "Drinking Water Analysis Reporting Form - Inorganic Chemical (Iocs) Composite" - Arizona

What Is Form DWAR10?

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 July 1, 2019;
  • 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 Form DWAR10 by clicking the link below or browse more documents and templates provided by the Arizona Department of Environmental Quality.

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Download Form DWAR10 "Drinking Water Analysis Reporting Form - Inorganic Chemical (Iocs) Composite" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
INORGANIC CHEMICAL (IOCs) COMPOSITE
*** Entry Point to the Distribution System (EPDS) Only ***
PWS ID
PWS Name
EPDS ID
Specimen Number
Sample Date
Time (24 HR)
1
2
3
4
5
Owner/Contact Person
Phone Number
Email Address
1
2
3
4
5
Compliance Sample Type:
< 3,300 Population
> 3,300 Population
*** COMPOSITE INORGANIC CHEMICAL ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Exceeds
MCL
Result
Method
Limit
Name
Code
Run Date
MCL
Reporting Limit
0.010
0.005
Arsenic
1005
2
1
Barium
1010
0.005
0.0025
Cadmium
1015
0.1
0.05
Chromium
1020
4
0.5
1025
Fluoride
0.002
0.001
Mercury
1035
10
2.5
Nitrate (as N)
1040
1
0.25
Nitrite (as N)
1041
0.05
0.025
Selenium
1045
0.006
0.003
Antimony
1074
0.004
0.002
Beryllium
1075
0.2
0.1
Cyanide
1024
No MCL
0.05
Nickel *
1036
0.002
0.001
Thallium
1085
No MCL
10
Sodium *
1052
*** 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 #1 [____________] #2 [____________] #3 [____________] #4 [____________] #5 [____________]
All units must be reported in
Subm it completed form to o : :
milligrams per liter (mg/L)
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
*
Contaminants with no MCL
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 10: Revised 07/2019
DRINKING WATER ANALYSIS REPORTING FORM
INORGANIC CHEMICAL (IOCs) COMPOSITE
*** Entry Point to the Distribution System (EPDS) Only ***
PWS ID
PWS Name
EPDS ID
Specimen Number
Sample Date
Time (24 HR)
1
2
3
4
5
Owner/Contact Person
Phone Number
Email Address
1
2
3
4
5
Compliance Sample Type:
< 3,300 Population
> 3,300 Population
*** COMPOSITE INORGANIC CHEMICAL ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Exceeds
MCL
Result
Method
Limit
Name
Code
Run Date
MCL
Reporting Limit
0.010
0.005
Arsenic
1005
2
1
Barium
1010
0.005
0.0025
Cadmium
1015
0.1
0.05
Chromium
1020
4
0.5
1025
Fluoride
0.002
0.001
Mercury
1035
10
2.5
Nitrate (as N)
1040
1
0.25
Nitrite (as N)
1041
0.05
0.025
Selenium
1045
0.006
0.003
Antimony
1074
0.004
0.002
Beryllium
1075
0.2
0.1
Cyanide
1024
No MCL
0.05
Nickel *
1036
0.002
0.001
Thallium
1085
No MCL
10
Sodium *
1052
*** 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 #1 [____________] #2 [____________] #3 [____________] #4 [____________] #5 [____________]
All units must be reported in
Subm it completed form to o : :
milligrams per liter (mg/L)
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
*
Contaminants with no MCL
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 10: Revised 07/2019