Form DWAR20 MONTHLY "Long Term 2 Enhanced Surface Water Treatment Rule (Lt2eswtr) Monthly Reporting Form for E.coli for Schedule 4 Systems (Serving Less Than 10,000 People)" - Arizona

What Is Form DWAR20 MONTHLY?

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 DWAR20 MONTHLY 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 DWAR20 MONTHLY "Long Term 2 Enhanced Surface Water Treatment Rule (Lt2eswtr) Monthly Reporting Form for E.coli for Schedule 4 Systems (Serving Less Than 10,000 People)" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
Long Term 2 Enhanced Surface Water Treatment Rule (LT2ESWTR)
Monthly Reporting Form for E.coli
*** For Schedule 4 Systems (Serving less than 10,000 people) ***
***
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 [____________]
YEAR [_____________]
Surface Water Intake ID [___________]
Intake Name [_________________________________]
Plant operated entire calendar month and sampled outside of 5 day window.◊
Plant operated entire calendar month and sampled according to schedule.
Plant operated partial calendar month and sampled outside of 5 day window.◊
Plant operated partial calendar month and sampled according to schedule.
Plant did not operate any day of this calendar month due to normal events.*
Plant did not operate any day of this calendar month 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 E. coli
Sample
Analysis Run
Method
Method
Specimen Number
Lab ID
Check Source Type
E. coli per 100 mL
Date
Time
Date
Time
Type
Number
Flowing Stream/Canal
Lake/Reservoir
GUDI
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 [______________________________________________]
Subm it completed form to:
DWAR 20 MONTHLY:
EM AIL:
WQD_Compliance_Data@azdeq.gov
-
or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
Revised 7/2019
For questions go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
DRINKING WATER ANALYSIS REPORTING FORM
Long Term 2 Enhanced Surface Water Treatment Rule (LT2ESWTR)
Monthly Reporting Form for E.coli
*** For Schedule 4 Systems (Serving less than 10,000 people) ***
***
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 [____________]
YEAR [_____________]
Surface Water Intake ID [___________]
Intake Name [_________________________________]
Plant operated entire calendar month and sampled outside of 5 day window.◊
Plant operated entire calendar month and sampled according to schedule.
Plant operated partial calendar month and sampled outside of 5 day window.◊
Plant operated partial calendar month and sampled according to schedule.
Plant did not operate any day of this calendar month due to normal events.*
Plant did not operate any day of this calendar month 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 E. coli
Sample
Analysis Run
Method
Method
Specimen Number
Lab ID
Check Source Type
E. coli per 100 mL
Date
Time
Date
Time
Type
Number
Flowing Stream/Canal
Lake/Reservoir
GUDI
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 [______________________________________________]
Subm it completed form to:
DWAR 20 MONTHLY:
EM AIL:
WQD_Compliance_Data@azdeq.gov
-
or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
Revised 7/2019
For questions go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.