Form DWAR6 "Drinking Water Analysis Reporting Form - Radionuclides (Rads) Adjusted Gross Alpha, Radium-226&-228, Uranium" - Arizona

What Is Form DWAR6?

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 DWAR6 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 DWAR6 "Drinking Water Analysis Reporting Form - Radionuclides (Rads) Adjusted Gross Alpha, Radium-226&-228, Uranium" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
RADIONUCLIDES (RADS)
Adjusted Gross Alpha, Radium-226&-228, Uranium
*** 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
15 pCi/L
3 pCi/L
Adjusted Gross Alpha
4000
3 pCi/L
Gross Alpha
4002
Radon
4004
30 μg/L
1 μg/L
Combined Uranium *
4006
Uranium-234 *
4007
Uranium-235 *
4008
Uranium-238 *
4009
5 pCi/L
1 pCi/L
Combined Radium (-226,-228)
4010
1 pCi/L
Radium-226
4020
1 pCi/L
Radium-228
4030
*** 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 [_____________________________________]
* Combined Uranium must be
Subm it completed form to:
reported in micrograms per liter
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 6: Revised 07/2019
DRINKING WATER ANALYSIS REPORTING FORM
RADIONUCLIDES (RADS)
Adjusted Gross Alpha, Radium-226&-228, Uranium
*** 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
15 pCi/L
3 pCi/L
Adjusted Gross Alpha
4000
3 pCi/L
Gross Alpha
4002
Radon
4004
30 μg/L
1 μg/L
Combined Uranium *
4006
Uranium-234 *
4007
Uranium-235 *
4008
Uranium-238 *
4009
5 pCi/L
1 pCi/L
Combined Radium (-226,-228)
4010
1 pCi/L
Radium-226
4020
1 pCi/L
Radium-228
4030
*** 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 [_____________________________________]
* Combined Uranium must be
Subm it completed form to:
reported in micrograms per liter
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 6: Revised 07/2019