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--iNSTRt,, I INS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD
<br /> COPY A (A.,k and use for your worksheet. HARGER SELF MONITORING REPORT t:
<br /> t DISC TR ACY i C I TY OF
<br /> Use ballpoint pen or typewriter for data entry on forms.
<br /> 3. Provide dates for beginning and ending in reporting period blocks. (CALIFORNIA REr4jiINAL WA71EIR QUALITY
<br /> 4. Provide data as specified under column headings.
<br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL SCIARD
<br /> 6. Appropriate signature is required at the bottom of the form. CiENTRAL VALLEY RILGION PC Box 1029
<br /> 7. Remove COPY 3 and retain for your records.
<br /> 8. Send COPY XXdWX)l XAAXPA*YjsXAAK 9(*XA"XX X XXXX 3201 S STqFET TRACY CALIF
<br /> SACRAMENTOP CA 95816 95376
<br /> YOUR REPORTING PERIOD ISFM-C—N T7H-L Y7:=A N D YOUR REPORTS MUST State -NPDES Permit PAGE
<br /> BE SUBMITTED BY [M DAYS FOLLOWING THIS PERIOD. Year Mo. Day Year Mo. Day Code Number Year Mo. Day
<br /> Date form was
<br /> ty Ye or R e p c�,r.,in g computer printed
<br /> a Per BeginningF7 7, C-;
<br /> 'acD!'i I th(P'0renpartf Ending
<br /> Q2 TraCn=ion
<br /> STATIOl' I DESCRIPTION
<br /> CONSTI 5E—NTNAME
<br /> UNITS
<br /> SAMPUETY-PE
<br /> PREQUENCY MONTH DAY :0400 10 ou 010
<br /> ------------
<br /> ------ ----- ---- ----------- ----------
<br /> ------------
<br /> "P51 77-777777',
<br /> I -----------
<br /> ---- - - ----
<br /> ------------I ------
<br /> -----------
<br /> -77,7, -----------
<br /> -----------
<br /> ------------
<br /> 77KM,
<br /> ------------ -------
<br /> -2-1
<br /> ----------- ----------- ----------- ----------- ----------
<br /> -----------
<br /> -----------
<br /> 7,,Z- 7--7 77'-� 77,7777
<br /> ,,7.77 -�,7 X74 7MR-K,
<br /> 3 --- ----------- ----------- ----------- ----------- ------------
<br /> 7'.
<br /> 7
<br /> ----------
<br /> ----------- ------- --- —- --- ---- --- -- ----------- -----------
<br /> ---- - - '77- 74,11 .7
<br /> I'll, I'll, t �, =11 11 .11, 11- 1.
<br /> v
<br /> o,"
<br /> 7�
<br /> ---- ......
<br /> & -"------ --4.r-------- ------- ------
<br /> -3-
<br /> 7,7777777 7,77777,77
<br /> -7-f,77-77, 7f,77If
<br /> v7f-fIM7'7& e
<br /> 77,757�7,17f,-,Mff,'I
<br /> 77 77,7f,77-,-7ff,,7fT,-� '0� X �"If
<br /> -=IM,'—az,7'077f-M/,,,,f-'
<br /> 4,
<br /> el ,
<br /> ------------ --------- - -------- -- ------------
<br /> < ----------- ----------- -- --------
<br /> --------- - ----------- ------
<br /> ------------ -------- ------------
<br /> -2 ------------ -----------
<br /> + MONTHLY AVERAGE 7,
<br /> MONTHLY HIGH
<br /> MONTHLY LOW 3
<br /> TOTAL RECORDINGS/MO.
<br /> -fEQUIREMENT #1
<br /> Times—Exceeded
<br /> REQUIREMENT #2
<br /> FT,mes Exceeded
<br /> REQUIREMENT #3
<br /> F Times—Exceeded 70�� IMI
<br /> *E niter number of accurate, and thc�ti(:!�, AL
<br /> sampli fare ing is true and Irt I a
<br /> Yr Mo.
<br /> taken during the day. for tre column constituents wm as speci- Si ture of Principal Executive /copy-
<br /> cility. �fficer or Authorized Ageint Date
<br /> For.02 9/74
<br />
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