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INSTRUCTIUoIS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTRC BOARD <br /> 1. Remove COPY 4 (dark yellow) and use for your worksheet. 7ER SELF MONITORING REPORT <br /> 2. Jse 6allpoint pen or typewriter for data entry on forms. DISCHARC j-'< TRACYv CITY OF <br /> <Z <br /> 3. Provide dates for beginning and ending in reporting period blocks. s. 1 <br /> 4. Provide data as specified under column headings. CAL] FOPINIA RF(JONAL WATER r�UALITY TRACY SIP <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL ROARD <br /> 6. Appropriate signature is required at the bottom of the form, C EINTRAL VALLEY REC-ION PC Box 1029 <br /> 7. Remove COPY 3 and retain for your records. <br /> 8. Send COPY)l XQW)K)RW0XAXXrXl%*AsX"at XWXX XKX X X X)()t X 3201 S STREET r2 TRACY CALIF <br /> SACRAMIENTC,v CA 95816 9 5 3 76 <br /> YOUR REPORTS MUST Q< <br /> YOUR REPORTING PERIOD ISF.?40NTt4LY <br /> BE SUBMITTED BY [f75 DAYS FOLLOWING THIS PERIOD. State NPDES Permit PA6L <br /> Year Mo. Day Year Mo. Day Code Number Year Mo. Day <br /> FQTraCn ion Facility Ye a nth or Repo ing Dote form w 0 <br /> 2 s.adcet I D I t hr,/,M r,p.r ff Pe ir' Beginning F780 IC Z 7,1] Ending I compu er printed <br /> I ad <br /> STATION DESCRIPTION <br /> CONSTITUENT NAME <br /> UNITS <br /> SAMPLE TYPE <br /> FREQUENCY <br /> MONTH DAY 70299 85002 50086 <br /> rm <br /> 5,4 <br /> C —————————— ——————————— ———Zo—————— <br /> ____ __2_ —' M777,,' 7-7,4v <br /> 7 711111 '111", <br /> 44" <br /> I—N 1`11111L_ <br /> ffls <br /> �4 <br /> S <br /> 'v <br /> — 77 7—7,71 <br /> �777 <br /> 0 <br /> ----------- <br /> Z ----.-z4 <br /> M, <br /> 7 <br /> 1�---- ----------- ----------- W <br /> 71 <br /> —4 i— 7,777,' <br /> _,c-A,� <br /> g <br /> Aj 'gf <br /> -7 <br /> "y. ....7,7 7, <br /> 7'7.7 071 <br /> 44�v, <br /> __ZZ————— ———— ——————————— di _z:al————— <br /> 777 7,7777, <br /> r <br /> 77, <br /> "I"Q2 Tap. M777 P <br /> ft <br /> 1�,11 - el�,——— ——————————— <br /> ------ ---- ----- ----------- �a_7------ <br /> ————— ——————————— ——————————— ———————— .4�­a_4————-- <br /> ------ ----------- -04---- <br /> ----------- 2------ <br /> + MONTHLY AVERAGE i 1 -7 V <br /> MONTHLY HIGH V, V-7q <br /> MONTHLY LOW ;z <br /> TOTAL RECORDINGS/MO. '!;t rN 6 <br /> _�EQUIREMENT #1 <br /> Times Exceeded <br /> REQUIREMENT #2 w <br /> FTimes Exceeded <br /> REQUIREMENT #3 <br /> Times Exceeded <br /> C) <br /> *Enter number of samples Typ d N�ame of Principe] Executive Officer for is true and accurate, and th (7� EPA <br /> C� t ego i n g 9 1 <br /> taken during the day. Darell Ile sam ling pr cedur6 and analysis used for , column constituents was as spea- P' Wo. Ddy <br /> Was mc COPY <br /> F.r.Q2-9 Lost First MI fied�ianmTe Waste Discha rge Order for this facility. S'V�fi' Astho Date <br /> re 0.,f <br />