Form DWAR20UV "Drinking Water Analysis Reporting Form - Disinfection Log Removal for Split Uv/Chemical Systems - Monthly Report for Surface Water Treatment" - Arizona

What Is Form DWAR20UV?

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 DWAR20UV 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 DWAR20UV "Drinking Water Analysis Reporting Form - Disinfection Log Removal for Split Uv/Chemical Systems - Monthly Report for Surface Water Treatment" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
DISINFECTION LOG REMOVAL
** For Split UV/Chemical Systems – Monthly Report for Surface Water Treatment **
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
________________________________________________
Report Date
Owner/Contact Person
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SAMPLE COLLECTION POINT
Plant Log Removal Requirements:
Treatment Plant Number [_______________________]
Giardia: 3
Virus: 4
Cryptosporidium: 3
REPORTING
Month [__________________]
Year [_______]
Was the Plant in operation this month?
YES
NO
*** DISINFECTION LOG REMOVAL ***
Calculate total monthly off-compliance water treated by recording the date/time, log removal credit, flow rate, and volume of
water treated during previous 4-hour time period for log removal credit calculation results less than or equal to log removal
requirements listed above. Procedures for calculating log removal requirements are described in the “Split UV and Chemical
Disinfection System Monitoring, Recordkeeping and Reporting Requirements.” If none occurred, enter “none.” Add additional
sheets if necessary.
Date/Time of Occurrence
Log Removal Credit
Flow Rate (MGD)
4-Hour Volume Treated
(MG) Flow Rate ÷ 6
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
Total Monthly Off-Compliance Volume Treated
A. Total monthly volume treated (MG):
B. The ratio of treated water meeting the specified limits:
(
)
=
[_______]
(
)
I hereby certify that the information provided in this report is accurate and correct to the best of my knowledge:
Authorizer, Printed Name [___________________]
Signature [__________________________________________]
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.
DWAR 20UV: Revised 7/2019
DRINKING WATER ANALYSIS REPORTING FORM
DISINFECTION LOG REMOVAL
** For Split UV/Chemical Systems – Monthly Report for Surface Water Treatment **
PUBLIC WATER SYSTEM INFORMATION
***
***
>>>> TO BE FILLED OUT BY SYSTEM PERSONNEL <<<<
[_______________]
________________________________________________
PWS ID Number
PWS Name
[_______________]
________________________________________________
Report Date
Owner/Contact Person
__________________________________
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
SAMPLE COLLECTION POINT
Plant Log Removal Requirements:
Treatment Plant Number [_______________________]
Giardia: 3
Virus: 4
Cryptosporidium: 3
REPORTING
Month [__________________]
Year [_______]
Was the Plant in operation this month?
YES
NO
*** DISINFECTION LOG REMOVAL ***
Calculate total monthly off-compliance water treated by recording the date/time, log removal credit, flow rate, and volume of
water treated during previous 4-hour time period for log removal credit calculation results less than or equal to log removal
requirements listed above. Procedures for calculating log removal requirements are described in the “Split UV and Chemical
Disinfection System Monitoring, Recordkeeping and Reporting Requirements.” If none occurred, enter “none.” Add additional
sheets if necessary.
Date/Time of Occurrence
Log Removal Credit
Flow Rate (MGD)
4-Hour Volume Treated
(MG) Flow Rate ÷ 6
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
Total Monthly Off-Compliance Volume Treated
A. Total monthly volume treated (MG):
B. The ratio of treated water meeting the specified limits:
(
)
=
[_______]
(
)
I hereby certify that the information provided in this report is accurate and correct to the best of my knowledge:
Authorizer, Printed Name [___________________]
Signature [__________________________________________]
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.
DWAR 20UV: Revised 7/2019