Form DWAR6A "Drinking Water Analysis Reporting Form Radionuclides (Rads) Man-Made Beta Particles & Photon Emitters" - Arizona

What Is Form DWAR6A?

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 DWAR6A 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 DWAR6A "Drinking Water Analysis Reporting Form Radionuclides (Rads) Man-Made Beta Particles & Photon Emitters" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
RADIONUCLIDES (RADS)
Man-Made Beta Particles & Photon Emitters
*** Entry Point to the Distribution System (EPDS) Only ***
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
[_____:________]
________________________________________________
Sample Date
Sample Time
Owner/Contact Person
(24HR CLOCK)
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SAMPLE TYPE
If Composite of Four Quarterly Samples
Reduced Monitoring
_______________]
Date Q1 Collected [
Quarterly Monitoring
_______________]
Date Q2 Collected [
_______________]
SAMPLE COLLECTION POINT
Date Q3 Collected [
Entry Point to the Distribution System [EPDS_____ ]
_______________]
Date Q4 Collected [
SAMPLE SITE ID [____________________________]
*** RADIONUCLIDE ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
MCL
Result
Method
Limit
Name
Code
Run Date
MCL
4 mrem/yr
4 pCi/L
Gross Beta
4100
20,000 pCi/L 1,000 pCi/L
Tritium
4102
10 pCi/L
Strontium-89
4172
8 pCi/L
2 pCi/L
Strontium-90
4174
1 pCi/L
Iodine-131
4264
10 pCi/L
Cesium-134
4270
*** 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 [_______________]
PWS Person Notified [_____________________________________]
DWAR 6A: Revised 07/2019
Subm it completed form to: o:
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.
DRINKING WATER ANALYSIS REPORTING FORM
RADIONUCLIDES (RADS)
Man-Made Beta Particles & Photon Emitters
*** Entry Point to the Distribution System (EPDS) Only ***
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
[_____:________]
________________________________________________
Sample Date
Sample Time
Owner/Contact Person
(24HR CLOCK)
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SAMPLE TYPE
If Composite of Four Quarterly Samples
Reduced Monitoring
_______________]
Date Q1 Collected [
Quarterly Monitoring
_______________]
Date Q2 Collected [
_______________]
SAMPLE COLLECTION POINT
Date Q3 Collected [
Entry Point to the Distribution System [EPDS_____ ]
_______________]
Date Q4 Collected [
SAMPLE SITE ID [____________________________]
*** RADIONUCLIDE ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
MCL
Result
Method
Limit
Name
Code
Run Date
MCL
4 mrem/yr
4 pCi/L
Gross Beta
4100
20,000 pCi/L 1,000 pCi/L
Tritium
4102
10 pCi/L
Strontium-89
4172
8 pCi/L
2 pCi/L
Strontium-90
4174
1 pCi/L
Iodine-131
4264
10 pCi/L
Cesium-134
4270
*** 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 [_______________]
PWS Person Notified [_____________________________________]
DWAR 6A: Revised 07/2019
Subm it completed form to: o:
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.