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INSTRUCTION- .-ORDISCHARGER CALIFORNIA STATE WATER RESOURCES CONTRO OARD
<br /> T. Remove COPY a(dark yellow) for use for yourworksheet.form. DISCHARGER SELF MONITORING REPORT '
<br /> 2. Use ballpoint pen or typewriter for data entry on forms.
<br /> 3. Provide dates for beginning and ending in reporting period blocks. -< TRACY♦ CITY 3F
<br /> 4. Provide data as specified under column headings. ' ALIFiVNId R ` ; "dAL WATER 'QUALIIrY <Z TRACY STP
<br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.), CONI R?L u1A K J
<br /> 6, Appropriate signature is required at the bottom of the form,
<br /> 7. Remove COPY 3 and retain for your records. ITRAL VALLE=Y '!�GICN PO BOX 14?9
<br /> 8. Send COPY$JagPXRbg1$biX,>Sf4tCFXd4dQsNsAd6d4X�PXXTo3CXXR 3 ' 1 S $T• ET `D" CA$ IF I
<br /> z,"„ TRACY
<br /> SA--RA'4CNT0v CA r'5PI6 0 95376
<br /> YOUR REPORTING PERIOD 'aLY AND YOUR REPORTS MUST f<
<br /> BE SUBMITTED BY i s DAYS FOLLOWING THIS PERIOD. State NPDES Permit PAC -
<br /> or Transaction Facility Yea r(Monih for Re orcin Year Mo. Day Year Mo. Day Code Number Year Mo. Day
<br /> Code I LD. �E'39�,1 IOS01 I this report 7`1 Period:g Beginning :Mf t Date form was `
<br /> I g Ending 79 I 31 �6 ?4I5k computer printed 73 O 2E
<br /> STATION DESCRIPTION
<br /> CONSTITUENT NAME
<br /> UNITS
<br /> SAMPLE TYPE { ,�
<br /> FREQUENCY
<br /> MONTH DAY 7G3 C' DtsG95 w.G "> z f t t
<br /> j- L218 SSS LSI
<br /> L N
<br /> 1 r' f { +T b ,n�St'.
<br /> --_ ,sy4 f✓ —
<br /> —J2� —_• __ : e14
<br /> $ N
<br /> -------------
<br /> 00
<br /> ---------
<br /> ;.a . . f
<br /> 77
<br /> zsv
<br /> --- s � � � �
<br /> 6
<br /> JcL �u . ?'
<br /> 777,77
<br /> `Y- 4✓ ?skrllk�li:f4=4Y'N4`Yx3w,fhf"r5f 4 Ylf.M.M'{<4 g$y"fl'f�YfRfM't'iM{' 4 t4a
<br /> ^a
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<br /> f
<br /> --- �L --------- ---a7�3_-- - ----
<br /> p>1 „C +,4 47 S—
<br /> 77,
<br /> '
<br /> �
<br /> `-
<br /> Y!h
<br /> rf.
<br /> 25 0
<br /> d ^� *�Y, t ,vox f f?
<br /> --- a6 -
<br /> —_ s3" s !T iY v fi �s h cnn f — 7 µF✓
<br /> wr+. mrf s�vkxr{t l: i { — µ«x.
<br /> l -- -----------
<br /> Y --- dj[ J ;.,,!'.�v,",r. >u " ��``%.;�.c:., „ r 's' "C '�.,[ T'`" f, ;m, ,,tt u,..�,lw,�+rr+✓h3f "ii�mr+a -,.s1{w:r.,+, - h+ s ti.. .+,f
<br /> Q ..., _lir$
<br /> - -----------
<br /> +
<br /> -- ---t MONTHLY AVERAGE f,f
<br /> MONTHLY HIGH
<br /> MONTHLY LOW
<br /> TOTAL RECORDINGS/MO
<br /> REQUIREMENT #7
<br /> Times Exceeded "��,no �! ,r'N>m qz.� ` r'� y.vFw., . N T ,°"" { . ...
<br /> v
<br /> REQUIREMENT #2
<br /> f i
<br /> Times Exceeded
<br /> r
<br /> REQUIREMENT #3
<br /> i J Times Exceeded ' ,°3 ", ''" f{{ �u,;:>h { {, a`YM �' gy;. cz '` ' kms..: ,z ea" >r 7
<br /> Enter number of samples Typed Name of Principal Executive Officer I declare under penalty of erur, that the fore oin is true and accurate, and that �,
<br /> taken during the day. Scott `, P Y P I Y g g
<br /> LCZr�e�.1 1) the sampling procedure and analysis.used for the column constituents was as ands
<br /> Q2-9/74 Last First MI tied in The Waste Discharge Order for this facility. Signature of principalExecutive Yr. Mo. Day CQ
<br /> Off aer or Authorized Agent Date
<br />
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