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—r — .— — INSTRUA. AS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD I. Remove COPY 4 (dark yellow) and use.for your worksheet. 2. Use ballpoint pen or typewriter for data entry an forms. DISCHARGER SELF MONITORING REPORT EVEN RESORTS• INC. 8. Provide dates for beginning and ending in reporting period blocks.Provide data os specified under column headings. C -CALIFORNIA REGIONAL WATER QUALITY P ARAOISE POINT MARINA . 5. Entermonthlysummary data(MONTHLY AVERAGE. MONTHLY HIGH, etc.). CUNTROL BOARD 6. Appropriate signature is required at the bottom of the form. CF NYRAL VALLEY REGION 11 We KIMBERLY AVE• STE 200 7. Remove COPY 3 and retain for your records. 8. Send COPY 2Ja1EPA�.PegI�KJKSXYFYbXc)siG76Xd(do14XKLX`XXXX 3443 ROUTIER ROAD �,w� LACENTIA *CA SACRAMENTO. CA 95827-3098 2670 YOUR REPORTING PERIOD IS '' L AND YOUR REPORTS MUST F` BE SUBMITTED BY [ DAYS FOLLOWING THIS PERIOD. State NPDES Permit Year Mo. Day Year Mo. Day Code Number Year Mo. Da Transaction Facilil Year Month lar /f / �) Re or fm 9 Date form was 2 Code LD. y 5£t391G41001 L th is report /lam` /P" Penodg Beginning 92 12 1 Ending 2 7 _r! Ob '�QOA�3 computer rioted P2/1116/111 STATION DESCRIPTION R- - CONSTITUENT NAME TUiiciIOtiY14IL)ITY FURL, URJ O M t _ UNITS ; TU U NT NTU Et; EIC DEG) ^EG F(C f1FG1 DCG F(C OE0 DEG F(C 01EG) SAMPLE TYPE CKA8H GRAB R :y- FREQUENCY WEEKLY EK Y itEEK K ri . ' MONTH I DAY A ---- J ------ -- ------------ -- ------------- -- ------------ -- ------------- -- ------------- -- ------------- -- ------------- -- ----- - ------------------------- ---------- � -- 5� ---- y----- ------------------------------------ ----- ----- -- ----��----------------- P�--- -� ---- --- -- ' -- -------- -s- ---- ------------------- -- - - -- ------------- -- ------------- ------------------------------ --------------- --------- -- - - -- ------------- -- --------- ---- -- ------------- - ---- -1---- ----------------------------------- -- - -- -- ----------- -------------------------------------- -- -- ------------- -- ------------- ------------- -- ----------- -- ------------- -- ------------- ------------------ -- ------------- -- ------------- -- ------------- -- ------------- -- ------------- ---- 77 -- ------------- -- ------------- -- ------------- --------------- - ------------- -- ---------- -- ------------- -- ------------- ------------------------------------ -- ------- ----- -- ------------- -------------------------------------------------------- -------------- ------ ---------------- - --------------------------------------- -- ------------- -- ____ /_--------------------------------------- - __ _____________ _ -------------- ------- __ _ __ __-------------------------------------------------- ----------------- ------------------- ----------------------- __ _____-____--_ __ -------------- ------------------- --- - -- ------------- --------------------------------------------------------- ------------------------------------ ------------- --- - /. --- :)7-------------------------------------------------------- - --- -------------------------------- -- ------------- ------------- ------------- - ----------------- --------------------- -- ------------- -- -- -------------------------------------- -- ------------- ---- -- ------------- -- ------------- -- ------------- -- ------------- -- -------------- -- ---- ---------------------- ---------- ---- -_ ------------------ ------------------------------------------ ------------- -- ------------- -- ------------- -- ------------- -- ------------- ---- - -- ------------- ------------------------------------------ ------------- -- ------------- -- ------------- -- ------------- -- ------------- - -- ---------------------- -------------- ------------------ ----------- ------------------------- ------------- ---- ----------------- ------------------------------------- -- ------------- ------------------------------------ W ---- -- ------------- -- ------------- -- -- -- -- --- ------------- -- ------------- -- -------------- < - - -- ------------- -- --------- a ---- -- w ---- --------- ------- -------- --------- t MONTHLY AVERAGE D• ` ,) � ' MONTHLY HIGH air O• Iq u MONTHLY LOW .3 O e)- TOTAL RECORDINGS/MO. REQUIREMENT NI Times Exceeded L E:E F H' rg - REQUIREMENT N2 Times Exceeded REQUIREMENT #3 Times Exceeded Enter number of samples Typed Nome al Pnnupal Ex�cuhve office 1 cert Yyy andar penally of law Thal ha a personally e.am ned a td a la ,Imr yr ih the format on subm t C.' > E�dL _ ted b th s document and all na h e vs and that bored on y qu y of those nd v'duols �mn ed olely - �//j/� '/./ / Ap token duringthe do (i°i/-�' /�/ L respons ble for obla-n ng the nfo mal n I bel e.e that theinformation-s true accurate and ram pt ele am MfY y aware shot there are s gn I tort penollles for sab nit ng false information mdudbg the pass billy of I'n S. aiur lei nlipal ER roan a)9 za Last First MI and im ri sonmenl g p �g llicer or Aulhon:ed, gm Dole