Form DWAR15 A & B "Drinking Water Analysis Reporting Form - Surface Water/Groundwater Under the Influence of Surface Water Treatment" - Arizona

What Is Form DWAR15 A & B?

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 April 1, 2020;
  • 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 DWAR15 A & B by clicking the link below or browse more documents and templates provided by the Arizona Department of Environmental Quality.

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DRINKING WATER ANALYSIS REPORTING FORM
SURFACE WATER/GROUNDWATER UNDER THE
INFLUENCE OF SURFACE WATER TREATMENT
*** Monthly Report to be filled out by system personnel ***
PUBLIC WATER SYSTEM INFORMATION
***
***
[________________]
[_________________________________________]
PWS ID Number
PWS Name
[________________]
[_________________________________________]
Report Date
Owner/Contact Person
[_______________________________]
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
:
SAMPLE LOCATION
MONITORING PERIOD
MONTH [________] YEAR [______]
Treatment Plant ID [TPSW_______]
*** COMBINED FILTER EFFLUENT TURBIDITY ***
YES
NO
Was the treatment plant in operation for the month being reported?
If the treatment plant was not in operation for the entire month, record the total
DAYS [______] HOURS [______]
number of days or hours the treatment plant was in operation during the month.
A. Total number of minimum residual disinfection concentration samples taken
[______]
or
Continuous
or indicate “Continuous” if samples were collected hourly, or more frequently
MAXIMUM TURBIDITY MEASUREMENT
[___________]
B. Number of turbidity samples exceeding the specified limits for the filtration technology used
Conventional or Direct Filtration Limit – 1 NTU
Slow Sand or Diatomaceous Earth (DE) Filtration Limit – 5 NTU
Alternative (cartridges, membranes, bags) Filtration Limit – 5 NTU
Record the date and value of turbidity measurements that exceed the specified limits for the filtration technology used
Date/Time Reported to Regulatory
Date/Time of Occurrence
Turbidity Value (NTU)
Agency
If none occurred, enter “NONE”
[___________]
C. Highest single turbidity reading for the month
95% TURBIDITY MEASUREMENT
D. Total number of filtered water turbidity measurements that are > the specified limits for the
[___________]
filtration technology used:
Conventional or Direct Filtration Limit – 0.3 NTU
Slow Sand or Diatomaceous Earth (DE) Filtration Limit – 1 NTU
Alternative (cartridges, membranes, bags) Filtration Limit – 1 NTU
E. The percentage of turbidity measurements that are > the specified limits:
[_________]
[_________]
/
[___________] %
X 100 =
D
A
Comments [___________________________________________________________________________________________]
Page 1 of 4
DRINKING WATER ANALYSIS REPORTING FORM
SURFACE WATER/GROUNDWATER UNDER THE
INFLUENCE OF SURFACE WATER TREATMENT
*** Monthly Report to be filled out by system personnel ***
PUBLIC WATER SYSTEM INFORMATION
***
***
[________________]
[_________________________________________]
PWS ID Number
PWS Name
[________________]
[_________________________________________]
Report Date
Owner/Contact Person
[_______________________________]
(_____)__________________________________
Owner/Contact Email Address
Owner/Contact Phone Number
:
SAMPLE LOCATION
MONITORING PERIOD
MONTH [________] YEAR [______]
Treatment Plant ID [TPSW_______]
*** COMBINED FILTER EFFLUENT TURBIDITY ***
YES
NO
Was the treatment plant in operation for the month being reported?
If the treatment plant was not in operation for the entire month, record the total
DAYS [______] HOURS [______]
number of days or hours the treatment plant was in operation during the month.
A. Total number of minimum residual disinfection concentration samples taken
[______]
or
Continuous
or indicate “Continuous” if samples were collected hourly, or more frequently
MAXIMUM TURBIDITY MEASUREMENT
[___________]
B. Number of turbidity samples exceeding the specified limits for the filtration technology used
Conventional or Direct Filtration Limit – 1 NTU
Slow Sand or Diatomaceous Earth (DE) Filtration Limit – 5 NTU
Alternative (cartridges, membranes, bags) Filtration Limit – 5 NTU
Record the date and value of turbidity measurements that exceed the specified limits for the filtration technology used
Date/Time Reported to Regulatory
Date/Time of Occurrence
Turbidity Value (NTU)
Agency
If none occurred, enter “NONE”
[___________]
C. Highest single turbidity reading for the month
95% TURBIDITY MEASUREMENT
D. Total number of filtered water turbidity measurements that are > the specified limits for the
[___________]
filtration technology used:
Conventional or Direct Filtration Limit – 0.3 NTU
Slow Sand or Diatomaceous Earth (DE) Filtration Limit – 1 NTU
Alternative (cartridges, membranes, bags) Filtration Limit – 1 NTU
E. The percentage of turbidity measurements that are > the specified limits:
[_________]
[_________]
/
[___________] %
X 100 =
D
A
Comments [___________________________________________________________________________________________]
Page 1 of 4
DRINKING WATER ANALYSIS REPORTING FORM
SURFACE WATER/GROUNDWATER UNDER THE
INFLUENCE OF SURFACE WATER TREATMENT
*** Monthly Report to be filled out by system personnel ***
PUBLIC WATER SYSTEM INFORMATION
***
***
[________________]
[_________________________________________]
PWS ID Number
PWS Name
:
SAMPLE LOCATION
MONITORING PERIOD
MONTH [________] YEAR [______]
Treatment Plant ID [TPSW_______]
*** INDIVIDUAL FILTER TURBIDITY ***
Note: If your system uses direct or conventional filtration and consists of two or fewer filters, you may conduct
continuous monitoring of combined filter effluent in lieu of individual filter effluent turbidity monitoring. Systems using
this option must complete this page. Systems not using direct or conventional filtration do not have to complete this
page.
YES
NO
1. Was each individual filter monitored continuously?
YES
NO
2. Were measurements recorded every 15 minutes?
3. Was there a failure in the continuous filter monitoring or 15 minute recording equipment
that lasted 4 or more hours (i.e., 16 or more continuous filter turbidity readings/recordings
YES
NO
missed due to equipment failure) during the month? If yes, indicate the date(s), duration,
and individual filter grab sampling frequency on a separate sheet.
INDIVIDUAL FILTER EVENT
[___________]
Did any individual filter exceed
4. 1 NTU in two consecutive measurements taken 15 minutes apart? If yes, complete the
YES
NO
table below and indicate required follow-up status (Filter Profile).
5. 0.5 NTU in two consecutive measurements taken 15 minutes apart at the end of the first four
YES
NO
hours of continuous operation after the filter has been backwashed, or otherwise taken offline?
If yes, complete the table below and indicate required follow-up status (Filter Profile).
6. 1 NTU in two consecutive measurements taken 15 minutes apart at any time in each of
three consecutive months? If yes, complete the table below and indicate required follow-
YES
NO
up status (Individual Filter Self-Assessment).
7. Yes No 2 NTU in two consecutive measurements taken 15 minutes apart at any time in each
YES
NO
of two consecutive months? If yes, complete the table below and indicate required follow-
up status (Comprehensive Performance Evaluation CPE).
Individual
Date/Time of
Filter Number
Turbidity Value (NTU)
Follow-up Action Taken (Y/N)*
Filter Event
Occurrence
Attach additional table, if necessary. If filter profile was not completed for 4 or 5, attach explanation.
Was an event reported for any individual filter listed in the table above during the previous
YES
NO
[_____________________________]
month? If yes, identify which filter(s)
Page 2 of 4
DRINKING WATER ANALYSIS REPORTING FORM
SURFACE WATER/GROUNDWATER UNDER THE
INFLUENCE OF SURFACE WATER TREATMENT
*** Monthly Report to be filled out by system personnel ***
PUBLIC WATER SYSTEM INFORMATION
***
***
[________________]
[_________________________________________]
PWS ID Number
PWS Name
:
MONTH [________] YEAR [______]
SAMPLE LOCATION
MONITORING PERIOD
Treatment Plant ID [TPSW_______]
*** ENTRY POINT TO THE DISTRIBUTUION SYSTEM (EPDS) MINIMUM RESIDUAL DISINFECTION
CONCENTRATION (RDC) ***
Was the treatment plant in operation for the month being reported?
YES
NO
If the treatment plant was not in operation for the entire month, record the total
DAYS [______] HOURS [______]
number of days or hours the treatment plant was in operation during the
month.
A. Total number of minimum residual disinfection concentration samples taken
[______]
or
Continuous
or indicate “Continuous” if samples were collected hourly, or more frequently
[______]
B. Record the number of occurrences of RDC less than 0.2 mg/l entering the
distribution system during the month
C. Record the lowest measurement of RDC in mg/l entering the distribution system. Put a "NO" if treated surface
water was not served for that day.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
D. Record any occurrences of RDC less than 0.2 mg/L entering the distribution system.
Date/Time Reported to
Hours until restored to
Date follow-up report to
Date/Time of Occurrence
Regulatory Agency
0.2 mg/L or above
Regulatory Agency
Page 3 of 4
DRINKING WATER ANALYSIS REPORTING FORM
SURFACE WATER/GROUNDWATER UNDER THE
INFLUENCE OF SURFACE WATER TREATMENT
*** Monthly Report to be filled out by system personnel ***
PUBLIC WATER SYSTEM INFORMATION
***
***
[________________]
[_________________________________________]
PWS ID Number
PWS Name
MONITORING PERIOD : MONTH [________] YEAR [______]
*** DISTRIBUTION SYSTEM MINIMUM RESIDUAL DISINFECTION CONCENTRATION (RDC) ***
A. [_________]
Number of instances where the RDC was measured
B. [_________]
Number of instances where the RDC was measured but not detected
Calculate the percentage of undetected residuals found
/
[___________] %
X 100 =
B
A
I hereby certify that the information provided in this report is accurate and correct to the best of my knowledge.
Authorized Signature [__________________________________________________________]
Submit all four (4) pages to:
EMAIL:
WQD_Compliance_Data@azdeq.gov
-or-
MAIL: ADEQ Water Quality Compliance Data Unit (MC 5415B-1),
DWAR 15 A & B:
For questions, go to: azdeq.gov/DWComplianceAssistance
1110 W. Washington St., Phoenix, AZ 85007.
Revised 4/2020
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