Form Dwar 2 - Drinking Water Asbestos Analysis Report (Page 2 of 2) in pdf

INSTRUCTIONS FOR USING THE ARIZONA DRINKING WATER

ASBESTOS ANALYSIS REPORTING FORM

Revised 2009

SYSTEM ID: This is a unique 5 digit Public Water System Identification (PWSID) number assigned to each public water system by

ADEQ.

SYSTEM NAME: This should be in the legal name which the water system has registered with the Arizona Corporation

Commission (ACC). If the system is a municipality or other non ACC regulated entity, this should reflect the legal structure, such as

XYZ Water Improvement District. Always notify the Department in writing of any name or ownership change.

SAMPLE DATE: The date the specimen was collected in mm/dd/yy format.

SAMPLE TIME: The time the specimen was collected in hh:mm format (24 hr clock time).

OWNER/CONTACT PERSON NAME: The first and last name of the owner or owner’s representative, (contact person) who

should be contacted with sample results.

OWNER/CONTACT PHONE#: The daytime phone number of the owner’s representative, (contact person) who should be

contacted with sample results.

SAMPLE TYPE: The compliance reason for specimen collection. Only the relevant sample types for each contaminant group are

provided on the ADEQ forms.

SAMPLE COLLECTION POINT/ID: The location within the water system where the sample was taken and it’s assigned

identifying number. Entry Point to the Distribution System -Use this location for synthetic organic chemical samples. Each sample is

taken at the “Entry Point to the Distribution System” which means the point at which water is discharged into the discharged into the

distribution system from a well, storage tank, pressure tank, or treatment facility. It is after treatment but prior to the first service

connection. These three digit numbers are assigned by ADEQ. All EPDS numbers need to be listed.

SAMPLING SITE ID: This is for your convenience so that you may put in an address or other location. This does not need to be

completed.

SPECIMEN NUMBER: A unique 15 character (max) alphanumeric code that identifies a particular sample used to test one

contaminant or one category of contaminants. If reporting on different reporting forms, a different (unique) number is required for

each contaminant group and for each report. If the sample analysis results exceed the reporting level, and you are required to take a

confirmation sample, this number will be used as the “Original Violating Specimen#” described below.

SPECIMEN NUMBER: A unique 15 character (max) alphanumeric code that identifies a particular sample used to test one

contaminant or one category of contaminants. If reporting on different reporting forms, a different (unique) number is required for

each contaminant group and for each report. If the sample analysis results exceed the reporting level, and you are required to take a

confirmation sample, this number will be used as the “Original Violating Specimen#” described below.

FOR MCL EXCEEDENCE ONLY/ORIGINAL VIOLATING SPECIMEN NUMBER: This is the unique 15 character

(maximum length) alphanumeric code that identified the original specific sample that initiated the repeat/confirmation sampling

requirement (See SPECIMEN# above). If a MCL value is exceeded, use the specimen id number associated with that MCL value.

PLEASE MAIL COMPLETED FORM TO:

ARIZONA DEPARTMENT OF ENVIRONMENTAL QUALITY

WATER QUALITY COMPLIANCE DATA UNIT

1110 W. WASHINGTON ST.

PHOENIX, AZ 85007

NOTE: These definitions are general in nature. For specific questions regarding your laboratory submittal, please contact the Arizona

Department of Environmental Quality (ADEQ) Water Quality Compliance Section at 1-800-234-5677, ext. 4624, or 602-771-4624.

-water quality-safe drinking water-forms reports and guidelines-lab reporting forms-Drinking Water Asbestos

Analysis Report .

Form Dwar 2 - Drinking Water Asbestos Analysis Report Page 2