Form DWAR17 "Drinking Water Analysis Reporting Form - Total Organic Carbon/Alkalinity (Toca)" - Arizona

What Is Form DWAR17?

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 DWAR17 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 DWAR17 "Drinking Water Analysis Reporting Form - Total Organic Carbon/Alkalinity (Toca)" - Arizona

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DRINKING WATER ANALYSIS REPORTING FORM
Total Organic Carbon/Alkalinity (TOCA)
*** Please see page 2 for TOCA Treatment Technique Compliance Rules ***
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 COLLECTION POINT
[__________]
Percent Removal Ratio (Or Alternative Criteria)
Surface Water Inlet [___________________________]
Running Annual Average [________________________]
Treatment Plant Number [_______________________]
SAMPLE TYPE
TOCA (Must be > 1.0 to meet compliance)
REPORTING
Alternative Criteria
Month [_____________]
Year [_____________]
System has Enhanced Softening
*** TOTAL ORGANIC CARBON / ALKALINITY ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Total Organic Carbon (2920)
[_________]
RAW
TREATED
Analysis Method
Sampling Site ID
Specimen Number
Analysis Run Date
Analysis Result (mg/L)
TOC Removed (Raw TOC – Treated TOC)
Percent TOC Removal (TOC Removed/TOC Raw)
Required TOC Removal (See page 2)
Removal Ratio (Percent TOC Removed/Required TOC Removed)
Alkalinity (1927)
[_________]
RAW
TREATED
Analysis Method
Sampling Site ID
Specimen Number
Analysis Run Date
Analysis Result (mg/L-CaCO
)
3
Alternative Criteria
Check the alternative criteria used for your facility for meeting TOCA:
[_________]
SUVA 2923 (L/mg-m) - Analysis Method:
[_________]
[_________]
and
TTHM (mg/L) - Analysis Method:
HAA5 (mg/L) - Analysis Method:
YES
NO
* Indicate if Cl2 is the only disinfectant through the system
[_________]
Magnesium as CaCO
- Analysis Method:
3
RAW
TREATED
Sampling Site ID
Specimen Number
Analysis Run Date
Analysis Result
*** 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 [_____________________________________]
Submit completed form to:
EMAIL: WQD_Compliance_Data@azdeq.gov -or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
DWAR 17: Revised 7/2019
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
DRINKING WATER ANALYSIS REPORTING FORM
Total Organic Carbon/Alkalinity (TOCA)
*** Please see page 2 for TOCA Treatment Technique Compliance Rules ***
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 COLLECTION POINT
[__________]
Percent Removal Ratio (Or Alternative Criteria)
Surface Water Inlet [___________________________]
Running Annual Average [________________________]
Treatment Plant Number [_______________________]
SAMPLE TYPE
TOCA (Must be > 1.0 to meet compliance)
REPORTING
Alternative Criteria
Month [_____________]
Year [_____________]
System has Enhanced Softening
*** TOTAL ORGANIC CARBON / ALKALINITY ANALYSIS ***
>>> TO BE COMPLETED BY LABORATORY PERSONNEL <<<
Total Organic Carbon (2920)
[_________]
RAW
TREATED
Analysis Method
Sampling Site ID
Specimen Number
Analysis Run Date
Analysis Result (mg/L)
TOC Removed (Raw TOC – Treated TOC)
Percent TOC Removal (TOC Removed/TOC Raw)
Required TOC Removal (See page 2)
Removal Ratio (Percent TOC Removed/Required TOC Removed)
Alkalinity (1927)
[_________]
RAW
TREATED
Analysis Method
Sampling Site ID
Specimen Number
Analysis Run Date
Analysis Result (mg/L-CaCO
)
3
Alternative Criteria
Check the alternative criteria used for your facility for meeting TOCA:
[_________]
SUVA 2923 (L/mg-m) - Analysis Method:
[_________]
[_________]
and
TTHM (mg/L) - Analysis Method:
HAA5 (mg/L) - Analysis Method:
YES
NO
* Indicate if Cl2 is the only disinfectant through the system
[_________]
Magnesium as CaCO
- Analysis Method:
3
RAW
TREATED
Sampling Site ID
Specimen Number
Analysis Run Date
Analysis Result
*** 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 [_____________________________________]
Submit completed form to:
EMAIL: WQD_Compliance_Data@azdeq.gov -or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
DWAR 17: Revised 7/2019
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.