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INSTRUCTc FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTk . 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. ai f Av '/y t It <br /> Y <br /> �. <br /> 4. Provide data as specified under column headings. r,ALTFf?RNTA h,^CI'OIAL WATER ;JALITY jd V <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL B UARD <br /> b. Appropriate signature is required at the bottom of the form. <br /> 7. Remove COPY 3 and retain for your records. NTRAL VALLEY REGJ3114 "�- <br /> 8. Send COPY 2.16 A,'Re'gyoh:g,YStfriY PX;alttb'is'ior�dSd COIRY 1,>Ao°s4)f,K X)t,'y X, 201 F STREET zw ( L!i- <br /> SACRAMENTO, CA 95316 <br /> YOUR REPORTING PERIOD IS 'T- f'`iLY AND YOUR REPORTS MUST F` <br /> s State NPDES Permit I <br /> BE SUBMITTED BY DAYS FOLLOWING THIS PERIOD. Year Mo. Day Year Mo Day Code Number Year Mo. Day <br /> E-7 Date form was <br /> Year Month for <br /> n action F 'I't Re orfin <br /> Tra s aci i y ( P 9 Q6 f a computer panted - <br /> Q? Code I I.0. 1 a � this report � � Period Beginning � r Ending r <br /> t STATION DESCRIPTION <br /> CONSTITUENT NAME <br /> UNITS "; ` <br /> SAMPLE TYPE M., `r <br /> FREQUENCY <br /> M_----_--O_—_--_--NTH Dle/Ac�aJ <br /> Y.l <br /> — t <br /> 7 <br /> 2 <br /> ------------ <br /> s7�C7L 4 2 L1— <br /> __— <br /> — <br /> 1751 <br /> = -------___ _—_ __ ---- -------- A — ----- --_� <br /> ----—_ <br /> y --`—�-- <br /> _-- <br /> _ <br /> --------------- <br /> - --- — ---__ —1 — — — <br /> _— <br /> jrp <br /> ' ---_---_ <br /> ti_ <br /> 1� 71Z <br /> -- <br /> —�I--1I -- <br /> --- <br /> —777 <br /> — ---— ------ rij <br /> — --- — — <br /> —, <br /> , <br /> — <br /> 61411 1. <br /> — -- — ------ — --- ------------- <br /> + <br /> — ---- <br /> t MONTHLY AVERAG /6' Cz3 7, x 2I <br /> MONTHLY HIGH 7- E: % '� <br /> MONTHLY LOW /3 SS _ <br /> TOTAL RECORDINGS/MO. <br /> tre <br /> REQUIREMENT #1 <br /> Times Exceeded K. <br /> t <br /> REQUIREMENT #2 <br /> x <br /> Times Exceeded <br /> REQUIREMENT #3 <br /> r� Times Exceeded , <br /> *Enter number Of samples Typed Name of Principal Executive Officer ''—'\ <br /> I declare under penalty of perjury that the foregoing is true and accurate, and that �e I <br /> taken during the day. SCO'tt dY'Y'2 ll• the sampling procedure and analysis used for the column constituents was as speci <br /> Last First MI fied in the Waste Discharge Order for this facility. S��ff e.e or' AorhoP�edFAcUrtVe Yr. Mo. Day COPY <br /> Form Q2-9/]4 ge^ Date <br />