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ISTRUCTIOI OR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTRI, BOARD - <br /> 1. Remove COPY 4 (dark yellow) and use for your forms. <br /> DISCHARGER SELF MONITORING REPORT <br /> '. 2. Use ballpoint pen or typewriter for data entry onn fforms. �� <br /> 3. Provide dates for beginning and ending in reporting period blocks. Qa R.ACY Y CITY t'F <br /> 4. Provide data as specified under column headings. CAL.IFUPNIA REGIONAL 4ATER EQUALITY LL rAcy sip <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL BOARD <br /> 6. Appropriate signature is required at the bottom of the form <br /> 7, Remove COPY 3 and retain for your records. CENTRAL VALLEY RE GIrN w RCW '1029 <br /> a. send coPY,z:w:fRC;r�ei k4 xah P6 � kxdl PKX KXX 3201 S STRt Z2 r ACY CAL F <br /> SACRAMENT''. y CA 95816 ao `'37F <br /> YOUR REPORTING PERIOD IS '-i'VTIH�Y AND YOUR REPORTS MUST F` <br /> BL SUBMITTED BY 0 DAYS FOLLOWING TH15 PERIOD. State NPDES Permit F P•`.f3� "`i I <br /> Transaction Focilit Year Month for Re orcin Date form was <br /> �' � Code LD. Y R99 '� `3n I. th� report � I Period:9 BeginningE717 <br /> _ay Ending Year Mo 1DayrT r. computer printed Year Code Nu ea Day <br /> �6i <br /> STATION DESCRIPTION nw I,: ax "*,, ry» . . ,r, ;w IRMO <br /> CONSTITUENT NAME <br /> SAMPLE TYPE <br /> FREQUENCY <br /> MONTH DAY J ,7 <br /> ------------- <br /> ---------- <br /> - ------------,. // { --,f r. ------------- <br /> v11ad ------------ �F+.vN ---------- <br /> 7-- _ <br /> -- 4+ __ — —_ _ -- <br /> —w <br /> —_— —___ » _ __ ___ �?-a _ _—_ _ __—_ _— _ _— <br /> -- ' —_____ <br /> C ___ -- <br /> t <br /> -- z _— <br /> -- <br /> Ig, <br /> - - - _� _ <br /> -- 1S ! 1` - M - - - - - <br /> -- 1 � _ _______ ttIftIl _ -- _-- ____-- _ <br /> -- 1L - --- n - - - --- - <br /> -- 1- ----- - / -- ---- - -- --- " ' -- --- -- -- <br /> In 7ff� <br /> L - - - _ <br /> L< <br /> -- _ _ - - - --- -- <br /> 1 <br /> - - -- _ - <br /> x '7 - �. <br /> — — _— _. — — — <br /> +4 +,W'R +�+ <br /> 4444, <br /> _— � --------- --___-- __--------- -- ——————— <br /> 77 1 7-1 — — — — ix� — — — '"4"^° <br /> — — — ---- ---- --__ -- --- — <br /> _— __--_ _ ___ ___ _—_ _ — <br /> , . ------ <br /> 7 <br /> ------------- <br /> % — � <br /> --- - I <br /> -- — — -- --- <br /> „ ,.: <br /> t MONTHLY AVERAGE - 4i Kr <br /> MONTHLY HIGH <br /> Z ° ' r <br /> .;` MONTHLY LOW <br /> TOTAL RECORDINGS/MO. <br /> REQUIREMENT #1 <br /> Times Exceeded ti <br /> REQUIREMENT #2 <br /> Times Exceeded ' <br /> REQUIREMENT #3 <br /> Times Exceeded Xf <br /> s <br /> ar <br /> T ed Nome of Principal Executive Officer <br /> �cEnter number of samples YP P I declare under penalty of perjury that the foregoing is true and accurate, and that _ �S <br /> taken during the day. the sampling procedure and analysis used for the column constituents was as sped- ( I r <br /> fied in the Waste Discharge Order for this facility. siq wre of Principal Executive've vr. Mt Day CC1PY <br /> For--Q2 9/74 <br /> Lost First MI g Y Officer or Authonxed Agent Date <br />