Form DWAR3A "Drinking Water Analysis Report - Aroclor" - Arizona

What Is Form DWAR3A?

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 DWAR3A 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 DWAR3A "Drinking Water Analysis Report - Aroclor" - Arizona

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DRINKING WATER ANALYSIS REPORT
AROCLOR
*** 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
SAMPLE COLLECTION POINT
Compliance Monitoring
Entry Point to the Distribution System [EPDS:_________ ]
SAMPLE SITE ID [_________________________________]
*** AROCLOR (PCB SCREENING TEST) ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Result
Method
Limit
Name
Code
Run Date
Reporting Limit *
0.00008
Aroclor 1016
2388
0.02
Aroclor 1221
2390
0.0005
Aroclor 1232
2392
0.0003
Aroclor 1242
2394
0.0001
Aroclor 1248
2396
0.0001
Aroclor 1254
2398
0.0002
Aroclor 1260
2400
*** 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 [_____________________________________]
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),
DWAR 3A: Revised 07/2019
For questions visit:
azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007
DRINKING WATER ANALYSIS REPORT
AROCLOR
*** 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
SAMPLE COLLECTION POINT
Compliance Monitoring
Entry Point to the Distribution System [EPDS:_________ ]
SAMPLE SITE ID [_________________________________]
*** AROCLOR (PCB SCREENING TEST) ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Analysis
Reporting
Contaminant
Cont.
Analysis
Exceeds
Result
Method
Limit
Name
Code
Run Date
Reporting Limit *
0.00008
Aroclor 1016
2388
0.02
Aroclor 1221
2390
0.0005
Aroclor 1232
2392
0.0003
Aroclor 1242
2394
0.0001
Aroclor 1248
2396
0.0001
Aroclor 1254
2398
0.0002
Aroclor 1260
2400
*** 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 [_____________________________________]
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),
DWAR 3A: Revised 07/2019
For questions visit:
azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007