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——------—------— <br /> INSTRUCTI( FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTIRC ;OARL <br /> 1. Remove COPY A (dark yellow) and use for your worksheet. <br /> 2. Use bollpoint pen or typewriter for data entry on forms. DISCHARGER SELF MONITORING REPORT <br /> 3. Provide dates for beginning and ending in reporting period blocks. �F,'< TRACY, CITY OF <br /> 4. Provide data as specified under column headings. CALIFORNIA IREGIONAL WATER QUALITY <Z TRACY STP <br /> 5� Enter monthly summary data (MONTHLY AVERAGE,MONTHLY HIGH, etc.). CONTROL BOA'kD <br /> 6. Appropriate signature is required at the bottom of the form. <br /> 7. Remove COPY 3 and retain for your records. CENTRAL VALLEY REGION PO Box 10 1 29 <br /> 8. Send COPY)OX"X)gVdfoXX,gArX%oUOk"XXOWX)(cXXX XXX)(X 3201 S STREET TRACY <br /> SACRAMENT01 CA 95816 CALIF <br /> �"95376 <br /> YOUR REPORTING PERIOD ISIMONTHLY AND YOUR REPORTS MUST <br /> BE SUBMITTED BY [131 DAYS FOLLOWING THIS PERIOD. State NPDFS Permit PAGE <br /> Q721 TraCnsa ion I a, Yea th for Reporolding Beginning Year Mo. Day Ending Year Mo. Day Code Number Date form was Year Mo. Day <br /> port Peri -77 <br /> ct cDi !ty t hr,/�M roe I compu er printecIF78/06 <br /> ale <br /> STATION DESCRIPTION <br /> Q-1"< <br /> CONSTITUE141 14-jy,, .. ......... <br /> I SAMPLE TYPE <br /> FREQUENCY <br /> 0040 0 <br /> ----------- ------1, ----------- ------ — <br /> --- ---- ----- ------------ — <br /> 77,7,7,7777- 7,7777, <br /> ---- --1 77, <br /> "M <br /> -CIA-zf-f��2 <br /> ----------- --- -------- <br /> 11---i"-f�,7-- ------ <br /> 7 <br /> Rtff <br /> 77 <br /> "7? <br /> —7 <br /> --- ------- --- <br /> :7,77 <br /> 712 17 <br /> --w Ai 7777777 -777,7' <br /> -12. <br /> ----------- <br /> -- ----------- <br /> ------------ <br /> ---- ------ <br /> -10 <br /> 77:7- 71. <br /> 7 <br /> ----------- <br /> ---------- <br /> > <br /> ,",77. ......... ra "i <br /> , 1 -7 7�-,,7�7 <br /> 77,7 777 �,,7, 7'. <br /> AW <br /> A <br /> ... .. ... <br /> ----------- <br /> �-- ---------- <br /> ------------ <br /> ------ Is <br /> ".4�k 77 77 <br /> ............ <br /> 4�jc?L77---- --1.......... <br /> A <br /> ----------- ------------- ---- --------- <br /> ----------- ---------- <br /> 30 <br /> ------ ----- ----- ------ -------- <br /> Z2 I ----------- ----- <br /> 'I- W <br /> + MONTHLY AVERAGE <br /> MONTHL <br /> Y HIGH 1 1 -7 9/) <br /> MONTHLY LOW 1 11 1 1 -) <br /> e -3 <br /> TOTAL RECORDINGS/MO. <br /> REQUIREMENT #1 <br /> Times Exceeded <br /> REQUIREMENT #2 <br /> F-R- 'I <br /> Time Ex st ed <br /> R <br /> REQUIRE E T 3 7 <br /> J� Time Ex ed <br /> *Enter number of samples Typed �j)me of Principal Executive Officer I declare under penalty of perjur� that the foregoing is true and <br /> taken during the day. 0 1 ;7 <br /> Form 07 9/74 Last- tied in the Waste Discharge Order for this facility. <br /> 11 the sampling procedure and onoysis used for the column constitu k, e:RS L EPA <br /> Flffell I �ufive Y,. Mo Day COPY <br /> ��n Date <br /> --------------- ------- <br />