Form DWAR33 "Drinking Water Analysis Reporting Form - Stage 2 Disinfection Byproducts (Tthm&haa5) Quarterly Report" - Arizona

What Is Form DWAR33?

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 DWAR33 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 DWAR33 "Drinking Water Analysis Reporting Form - Stage 2 Disinfection Byproducts (Tthm&haa5) Quarterly Report" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
STAGE 2 DISINFECTION BYPRODUCTS (TTHM&HAA5)
Quarterly Report
*** Distribution System Only ***
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
THIS REPORT COVERS YEAR AND CALENDAR QUARTER
[___________]
ST
ND
RD
TH
YEAR
1
QUARTER
2
QUARTER
3
QUARTER
4
QUARTER
Were any Operational Evaluation Levels (OELs) for TTHM exceeded during quarter?
YES
NO
If YES, list the calculated OEL per location (site ID) for TTHM. (Attach Additional Sheet if Needed)
Stage 2 Compliance
Current Quarter
Site ID
Result
OEL Calculated Result
(mg/L)
Monitoring Site ID
Sample Date
TTHM
TTHM
TTHM
Were any Operational Evaluation Levels (OELs) for HAA5 exceeded during quarter?
YES
NO
If YES, list the calculated OEL per location (site ID) for HAA5. (Attach Additional Sheet if Needed)
Stage 2 Compliance
Current Quarter
Site ID
Result
OEL Calculated Result
(mg/L)
Monitoring Site ID
Sample Date
HAA5
HAA5
HAA5
SEC. 141.626 OPERATIONAL EVALUATION LEVELS
(a) You have exceeded the operational evaluation level at any monitoring location where the sum of the two previous quarters'
TTHM results plus twice the current quarter's TTHM result, divided by 4 to determine an average, exceeds 0.080 mg/L, or where
the sum of the two previous quarters' HAA5 results plus twice the current quarter's HAA5 result, divided by 4 to determine an
average, exceeds 0.060 mg/L.
(Results from the previous two quarters + (2 x current quarter's result)) / 4
OEL
=
Authorized Signature [__________________________________________________________]
Page 1 of 3
DRINKING WATER ANALYSIS REPORTING FORM
STAGE 2 DISINFECTION BYPRODUCTS (TTHM&HAA5)
Quarterly Report
*** Distribution System Only ***
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
THIS REPORT COVERS YEAR AND CALENDAR QUARTER
[___________]
ST
ND
RD
TH
YEAR
1
QUARTER
2
QUARTER
3
QUARTER
4
QUARTER
Were any Operational Evaluation Levels (OELs) for TTHM exceeded during quarter?
YES
NO
If YES, list the calculated OEL per location (site ID) for TTHM. (Attach Additional Sheet if Needed)
Stage 2 Compliance
Current Quarter
Site ID
Result
OEL Calculated Result
(mg/L)
Monitoring Site ID
Sample Date
TTHM
TTHM
TTHM
Were any Operational Evaluation Levels (OELs) for HAA5 exceeded during quarter?
YES
NO
If YES, list the calculated OEL per location (site ID) for HAA5. (Attach Additional Sheet if Needed)
Stage 2 Compliance
Current Quarter
Site ID
Result
OEL Calculated Result
(mg/L)
Monitoring Site ID
Sample Date
HAA5
HAA5
HAA5
SEC. 141.626 OPERATIONAL EVALUATION LEVELS
(a) You have exceeded the operational evaluation level at any monitoring location where the sum of the two previous quarters'
TTHM results plus twice the current quarter's TTHM result, divided by 4 to determine an average, exceeds 0.080 mg/L, or where
the sum of the two previous quarters' HAA5 results plus twice the current quarter's HAA5 result, divided by 4 to determine an
average, exceeds 0.060 mg/L.
(Results from the previous two quarters + (2 x current quarter's result)) / 4
OEL
=
Authorized Signature [__________________________________________________________]
Page 1 of 3
DRINKING WATER ANALYSIS REPORTING FORM
STAGE 2 DISINFECTION BYPRODUCTS (TTHM&HAA5)
Quarterly Report
*** Distribution System Only ***
TTHM MCL: 0.080 mg/L
Report the Quarterly Results and Locational Running Annual Average (LRAA) for each
HAA5 MCL: 0.060 mg/L
Site ID.
Period = 1 Quarter (90 days)
One
Two
Three
Stage 2 Compliance
Result
Current
LRAA
Exceeds
Site ID
Period
Periods
Periods
Monitoring Site ID
(mg/L)
Period
(mg/L)
MCL
Ago
Ago
Ago
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
**Attach Additional Sheet if Needed
All units must be reported in
Submit completed form to:
milligrams per liter (mg/L)
EMAIL: WQD_Compliance_Data@azdeq.gov or
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
DBPR@azdeq.gov
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 33: Revised 07/2019
For questions, go to: azdeq.gov/DWComplianceAssistance
Page 2 of 3
DRINKING WATER ANALYSIS REPORTING FORM
STAGE 2 DISINFECTION BYPRODUCTS (TTHM&HAA5)
Quarterly Report
*** Distribution System Only ***
TTHM MCL: 0.080 mg/L
Report the Quarterly Results and Locational Running Annual Average (LRAA) for each
HAA5 MCL: 0.060 mg/L
Site ID.
Period = 1 Quarter (90 days)
One
Two
Three
Stage 2 Compliance
Result
Current
LRAA
Exceeds
Site ID
Period
Periods
Periods
Monitoring Site ID
(mg/L)
Period
(mg/L)
MCL
Ago
Ago
Ago
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
Sample Date
TTHM
0
HAA5
0
**Attach Additional Sheet if Needed
All units must be reported in
Submit completed form to:
milligrams per liter (mg/L)
EMAIL: WQD_Compliance_Data@azdeq.gov or
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
DBPR@azdeq.gov
1110 W. Washington St., Phoenix, AZ 85007.
DWAR 33: Revised 07/2019
For questions, go to: azdeq.gov/DWComplianceAssistance
Page 3 of 3
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