Laserfiche WebLink
STRUCTIONS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD <br /> 1. Remove COPY 4 (dark yellow) and use for your worksheet r <br /> 2. Use ballpoint pen or typewriter for data entry on forms. DISCHARGER SELF MONITORING REPORT <br /> 3. Provide dates for beginning and ending in reporting period blocks. aZ 71<ACY, (, TiY 'F <br /> 4. Provide data as specified under column headings. CALIFORNIA REGIONAL WATER QUALITY LL Tr'ACY STsP <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL. BOARD J <br /> b. Appropriate signature is required at the bottom of the form. CENTRAL VALLEY REGION <br /> tI <br /> y <br /> 7. Remove COPY 3 and retain for our records. 'z - <br /> 8. Send COPY A:##E4A.tt®eYolt4,Z6 n3FFa*acisdod$ 3SClJI 4.aXXXi,' 3201 S STREETzw 7 . '.Y CALIF <br /> SACRAMENTOV CA 95916 tz <br /> YOUR REPORTING PERIOD IS "4,0A:3 ALY AND YOUR REPORTS MUST Ea i <br /> BE SUBMITTED BY M DAYS FOLLOWING THIS PERIOD. State NPDES Permit ^ <br /> Year Mo. Day Year Mo Day Code Number Year Mo. Day <br /> Transaction Facile} Year(Mo nth for Reporting Date form was t, <br /> I I a9 s S o Endm ? 05 06 > t '• <br /> �z 2 Code I D Y � 7 r a rs this report pe <br /> Beginning g computer printed d <br /> STATION DESCRIPTIONIs + w t ++t ;, <br /> CONSTITUENT NAME <br /> UNITS <br /> SAMPLE TYPE A <br /> FREQUENCY <br /> y J <br /> MON TH DAY '. <br /> r17—a'v — — — zry <br /> 77 +N ,ww=,,. .h= <br /> 21, <br /> --- G2 — — <br /> --- <br /> -- �_ — -- -- — -- - <br /> -- — — -- <br /> Y <br /> --- — — -- -- -- --- — ---- ------- -- — -- <br /> - <br /> — — -- --- <br /> t <br /> -- — — --- — <br /> --- — — <br /> — —7 — <br /> ,+ ��- —Y — "5 ..ter v3 wY p++?T W*Y ems' <br /> —_. ..,..._ M ..u,y� <br /> f+' dYnN 1++ — urvvf <br /> - <br /> --_ <br /> „ r — — -- ----- — — — -- <br /> ---_ <br /> -> <br /> _ # — -`� -- ws«e — — -- +Y-+,' — — ?w.6, — _— -- — ---- <br /> 17, <br /> --- ---- _ —, — — — — -------- <br /> _ —, <br /> --- T _ _ _ _ <br /> ———— —`` -- ———— 9 — +. i+r+ S �---u:� — -- _--- --- --` ,--- <br /> '+Y hr'+�s av <br /> lL— ,.y s-+I.F ---- ..r r}. t`.S w. --.a-L — _S1 SLO--- ff, — JJ U G-• y,< •�.G'.f"' -- �f Z2 <br /> --- <br /> --- T <br /> h <br /> --- - <br /> - - <br /> Y 5«.r _, _ <br /> —77 <br /> _ <br /> =�2 /� 1 LZ—-- '11-- r Q --- -- — --- ------------- <br /> -- <br /> — --- <br /> w3u ----------- ------ ———— . — ----------- ----- <br /> 011 ai <br /> t MONTHLY AVERAGE tr/' !f. f Z - y„ �_ Z <br /> MONTHLY HIGH ="'j _. , cY.. <br /> MONTHLY LOW J19 j 0 -,i.51 1 <br /> TOTAL RECORDINGS/MO <br /> REQUIREMENT #1 <br /> Times Exceeded <br /> REQUIREMENT #2 ' <br /> Times Exceeded <br /> z <br /> REQUIREMENT #3 <br /> ` r y <br /> Times Exceeded <br /> *Enter number of samples Typed Name of Principal Executive Officer <br /> P I declare under penalty of perjury that the foregoing is true and accurate, and that <br /> taken during the day. 13 c'3.k2T' ,John the sampling procedure and analysis used for the column constituents was as spec- d oe, <br /> ed in the Waste Discharge Order for this facility. Si azure of Principal Executive Yr. Mo, Day <br /> Form 02-9/]4 fast FirstPY <br /> ti <br /> MI <br /> l <br /> 9 Y aficer or Authorized Agent pate CQ <br />