Laserfiche WebLink
-'INSTRUCTI�NS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES C� TROL BOARD <br /> 1. Remove COPY 4 (dark yellow) and use far your worksheet. DISCHARGER SELF MONITORING REPORT <br /> �Z i"TTY <br /> 2. use ballpoint pen or typewriter for data entry on forms. Q <br /> 3. Provide dates for beginning and ending in reporting period blocks. REGIONAL WA I QP( n' <br /> ,,, Provide clato as specified under column headings. LY HIGH, etc.). CONTROL 50AP�D <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTH CENTRAL VALLEY REG11N 1029 <br /> 6. Appropriate signature is required at the bottom of the form. -Jt� R r- <br /> 7. Remove COPY 3 and retain for your records. STP,�'CT z ACY <br /> 48. Send COP'Xy**NAXftAN9(Xab)f*Xcy6&)b'(CXWPXX'6.XXXX 5'76 <br /> SACRA1!4,ENTQlt CA 5 f-',16 4. - <br /> YOUR REPORTING PERIOD 15 AND YOUR REPORTS MUST FA5E 31 <br /> State NPDES Permit <br /> DAYS FOLLOWING THIS PERIOD. Year Mo. Day Year Mo. Day Code Number Year Mo. Day <br /> BE SUBMITTED By Dote form <br /> Yeor/Month for Reporting Beginning Ending I computer Pr <br /> art 2 112 <br /> 1 Code 1 --111 FacDil!ly this rep Period: <br /> Q2 Tr'ns'ct"nF <br /> STATION DESCRIPTInN <br /> CONSTITUENT NAME <br /> ,SAMPLE TYPE UNITS <br /> FREQUENCY <br /> MUNIN UAT <br /> ----------- --------- M,7,77",,7-77— <br /> '777, 7 777 <br /> ,77,77,,7777,777,7—i ,7 <br /> g" <br /> IL <br /> ——————————— ——————————— <br /> ——————————— ——————————— <br /> 7—�17= 1177", '=-77 <br /> K P <br /> o� <br /> ----------- ----------- ----------- --- <br /> AN <br /> 4-3 ----------- <br /> Ly 7-7,-, 7777 7777 7—',7777,"' <br /> ---------- <br /> 81-0 <br /> 77,,-, 71171-1117 <br /> ----------- ---------- -------- <br /> ------ ----------- <br /> ----------- — --------- ----------- ------- --- <br /> ----------- ----------- ----------- <br /> + MONTHLY AVERAGE �A 2— <br /> MONTHLY HIGH 12. , 2— <br /> MONTH— -- &4 '2 <br /> TOTAL RECORDINGS/MO. <br /> REQUIREMENT #1 <br /> Times Exceeded <br /> RE UIREMENT,#2 <br /> Time Ex eede <br /> REQUIREME T 3 <br /> Times Exceede <br /> *Enter number of samp es Type Name of Principal Executive I declare under penalty of perjurf, that the for%ing is true and y. Mo. Day <br /> the day. the sating procedure and anayfsis used for t e column constituents was as s eci Sigalure of Principal Execut Date COPY <br /> taken during vvp�I 1 0 A,�rt <br /> Last mrst fied in t e Waste Discharge Order r this facility. ficer or Authorized <br /> Form 02-9/74 <br />