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INSTRUC �S FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTR BOAka
<br /> 1. Remove COPY 4 (dark yellow) and use for your worksheet.
<br /> 2. Use ballpoint pen or typewriter for data entry on forms. DISCHARGER SELF MONITORING REPORT
<br /> �ZE
<br /> 3. Provide dates for beginning and ending in reporting period blocks. u)< TRACYt CITY OF
<br /> 4. Provide data as specified under column headings. CALIFORNIA REGIONAL WATER QUALITY 4z TRACY STP
<br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.).
<br /> 6. Appropriate signature is required at the bottom of the form. CONTROL BOARD
<br /> 7. Remove COPY 3 and retain for your records. CE04TRAL VALLEY R.EGION PO BOX 1029
<br /> 8. Send COPY XXqWX)gy&*XXXXXfX"XcXAX I(VX)QXQXXX XXXX X 3201 S S7RF+7 ov, I
<br /> z-- TRACY
<br /> SACRAMENTO# CA 95816 1 5��n 9 5 3 76
<br /> YOUR REPORTING PE ---]AND YOUR REPORTS MUST
<br /> MOD ISIMONTHLY
<br /> BE SUBMITTED BY Fr5-1, DAYS FOLLOWING THIS PERIOD. State NPIDES Permit PAG�
<br /> Q72 TraCn=ion Lea tlor Repc�r in 9 Year Mo. Day Year Mo. Day Code Number Dote form was Year Mo. Day
<br /> 'acil!ty t ri�Mor�nptcr I Periotd.. Ending computer prin ed [78/06/15
<br /> LD h Beginning
<br /> STATION DESCRIPTION
<br /> CONSTITUENT NAME
<br /> R`4
<br /> UNITS
<br /> SAMPLE TYPE
<br /> FREQUENCY
<br /> MONTH DAY 1 00300 0010 0 00070 0 070 0 1
<br /> --- ------- ------------ ------------ ----------- ----------- --- ------
<br /> ----- -----------
<br /> -77---———— 77 ",77;z,"
<br /> 3
<br /> �14
<br /> ——————————— ——————————— ——————————— ———————————
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<br /> I I I...If 77,77 7,1 777�,7,7, 777�—477��=77
<br /> 77, -7 7"77777 77;�
<br /> 'If p,
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<br /> Z�'xo ————— -I Il,p#777 Ir 77 171,
<br /> ILL 12,04'.1 77A7,p6,?-A,,' 77
<br /> lt
<br /> IN`
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<br /> ',7�77f,'7777,7,77,1— 7,77,777,7"f 4�-
<br /> "-7
<br /> 7777477,1777 7777",
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<br /> ----------- ----------- ----------- ----------- ------------
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<br /> �7777 17
<br /> 1:7 777f-�77 77�,I—'I 77,,'�7,77, 7,
<br /> ;77,777,7777-7-7,
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<br /> ——————————— ——————————— ——————————— ——————————— -——————————— ——————————— ———————————-
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<br /> '77-7777=77,7,77777,
<br /> 0�0 t— —tt,t,
<br /> �LAI
<br /> ——————————— ———————————-
<br /> -——————————— -—————— ———— ——————————— —————————
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<br /> I-77tI —7�M777777
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<br /> �77777 71 r*7717777),I,7,,
<br /> ",'I In
<br /> W II
<br /> 0c
<br /> ----------- -----------
<br /> R ------------ -----------
<br /> ----------- ------------
<br /> ----------- ------------ --- --------- -11 -----------
<br /> I F---T tj CY "N ," ------------
<br /> + MONTHLY AVERAGIF` 2, 7-' j, �.) 2 9� 79' ; ,�p 2
<br /> MONTHLY HIGH /61 0 71
<br /> MONTHLY Low � !t 1
<br /> TOTAL RECORDINGS/MO. L)
<br /> '7
<br /> REQUIREMENT #1
<br /> FTimes Exceeded
<br /> REQUIREMENT #2
<br /> "M
<br /> 8, IN
<br /> Times Exceeded
<br /> M11141
<br /> W
<br /> REQUIRDWENT #3
<br /> cled Typed 01
<br /> *Enter number of samples Name of Principal Executive Office, 1 declare under penalty of e that the foreging,is true and accurate, and th t I We
<br /> urfysis u ed for 9 1,
<br /> taken during the day. T)���p I I the sarnrling procedure angarna 5 e coumn constituents was as speci- EPA
<br /> Q2-9/74 Lost First fied in t e Waste Discharge Order for this facility. —Sigature of Princip6l'T.ecufl�o Y,�' -Ako. bof, COPY
<br /> ficer or Authorized Agent Date 2
<br />
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