|
INSI—CTIONS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES C—ONTROL b
<br /> 11. Remove COPY 4 (dark yellow) and use for your worksheet. OARD
<br /> , 2. Use ballpoint pen or typewriter for data entry on forms. DISCHARGER SELF MONITORING REPORT
<br /> 3. Pro,,de dates for beginning and ending in reporting period blocks.
<br /> j,< T9,ACYf CITY OF
<br /> <Z
<br /> 4. P—ocl� do,. — �pacifiad ad.r c.l.raa he.dm,s. CALIFORNIA QEGIQNAL WATER QUALITY
<br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). TRACY SIP
<br /> 6. Appropriate signature is required at the bottom of the form. CONTROL BOARD
<br /> 7. Remove COPY 3 and retain for your records. CENTRAL VALL#rY REGION j Sox 1029
<br /> 8. Send COPY R)OWKXMi�XX,XMrXIX*MA"aKk(*XXX�XXX XX)EXI* 3201 S STRSFT PC
<br /> SACRAMOYTOt CA ,95816 Z�w TRAC;Y CALIF
<br /> 95376
<br /> YOUR REPORTING PERIOD ISFM—ONTHLY AND YOUR REPORTS MUST
<br /> BE SUBMITTED BY L12j DAYS FOLLOWING, TH15 PERIOD. State NPDE5 Permit PAGE
<br /> Q72 I TraCn soct ion 'a il!ty Ye or Reporting Year Mo. Day Year Mo. Day Code Number Date for Year' Mo. Day
<br /> ode cD ath(IM or.npt a r t' Period: Beginning 176/09 Ending to/09/30 computer mrinfe'd r7r,75 T 77
<br /> STATION DESCRIPTION
<br /> CONSTIlUtN1 NAMt:
<br /> IIWITq
<br /> SAMPLE I Trt
<br /> FREQUEmry
<br /> .1 or Go
<br /> —21
<br /> Ilk"-111"'I's 111111% �7�, 7,.7,777-, 77-7777 7,-7,-:�' ,7
<br /> "I klll"1 7 7=
<br /> ft TIL�`,1;141'
<br /> 7
<br /> -V--<�———— ——————————— ———————————
<br /> 7 —Z————--
<br /> r 77777,77,
<br /> 7,7
<br /> -c
<br /> f�LLL
<br /> ----------- ———————————
<br /> Z-02 —————— ————
<br /> 14 711 1
<br /> 77,77 '�.�77,777,7 11�, MI. 11,11,
<br /> '74,4F *,� 4,44,-4 7&,m z,,, ,�717,771
<br /> 77,7_ 471-
<br /> `77*7
<br /> M..77-
<br /> "k
<br /> 7,77
<br /> ��e----- ———————— -------
<br /> Jq �-� -A �—I- ------
<br /> 7j-�111 - 7
<br /> 3,5"."0 , c- -4-
<br /> 1., 1417 `14 4 M,,-I
<br /> u
<br /> lcmi�-'z---
<br /> ----- ----------- ----------- ---I?-------- ------
<br /> g,
<br /> 477 K
<br /> -7 77=77
<br /> g5k,77,77
<br /> ----------- ———
<br /> 71
<br /> g7
<br /> 40
<br /> 0M
<br /> ———— ——————————— ———————————
<br /> a 6 -14J44————
<br /> 77
<br /> Zgf �,,o Peg gm�
<br /> =4,��XX`l
<br /> -a2
<br /> 7077
<br /> I
<br /> I
<br /> 2-;? —————— ----------- ————————
<br /> --4-;L------ -I—)-------
<br /> ---- ——————————— — ——————— ———
<br /> + MONTHLY AVERAGE
<br /> ��2 �! �IGH
<br /> MONTtHLL�Y LOW
<br /> TOTAL RECORDINGS/MO.
<br /> REQUIREMENT #1
<br /> FTimes—Exceeded
<br /> REQUIREMENT #2 9,
<br /> [—T�imesExceeded
<br /> REQUIREMENT #3
<br /> Times Ex
<br /> ceeded
<br /> *Enter number of samples Typed Name of Principal Executive Oft
<br /> token during the day. i��I declare under penalty of perjurr, that the foregoing is true and accurate, and th9t1 (�1111.11 ov 6
<br /> SQQtt Darre I I the sating procedure and amaysis used for the column constitu
<br /> For�02 9174 Last First fied in t e Waste Discharge Order for this facility. e... SiVa 'fit
<br /> �Ml fjure of Principal Yr. Mo. Day
<br /> f icer or Authorized gsnt Date
<br /> L
<br />
|