Form DWAR2C "Drinking Water Analysis Reporting Form Asbestos Composite" - Arizona

What Is Form DWAR2C?

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 DWAR2C 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 DWAR2C "Drinking Water Analysis Reporting Form Asbestos Composite" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
ASBESTOS COMPOSITE
** Entry Point to the Distribution System or Distribution System Only **
PWS ID
PWS Name
Site 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
Sample Collection Point:
Entry Point to the Distribution System (EPDS)
Distribution System
*** COMPOSITE ASBESTOS ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Exceeds
MCL
Result *
Limit
MCL
Reporting Limit
Method
Name
Code
Run Date
7 MFL
0.2
Asbestos
1094
*** 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:
million fibers per liter (MFL)
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 2C: Revised 07/2019
DRINKING WATER ANALYSIS REPORTING FORM
ASBESTOS COMPOSITE
** Entry Point to the Distribution System or Distribution System Only **
PWS ID
PWS Name
Site 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
Sample Collection Point:
Entry Point to the Distribution System (EPDS)
Distribution System
*** COMPOSITE ASBESTOS ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Exceeds
MCL
Result *
Limit
MCL
Reporting Limit
Method
Name
Code
Run Date
7 MFL
0.2
Asbestos
1094
*** 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:
million fibers per liter (MFL)
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 2C: Revised 07/2019