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INSTRL )NS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD I. Remove COPY 4 (dark yellow) and use for your worksheet. DISCHARGER SELF MONITORING REPORT = 2. Use ballpoint pen or typewriter for data entry on forms. uQ SE VLA kL"Su({TSr 1hC• 3. Provide dales for beginning and ending in reporting period blocks. 4. Provide data as specified under column headings. CALIFORNIA REd;IGNAL it QjALITY <ZPARADISE POINT MARINA 5. Enter monthly summary data (MONTHLY AVERAGE. MONTHLY HIGH, etc.). CONTROL BOARD ui 6. Appropriate signature is required at the bottom of the form. 711 w. ; 7. Remove COPY 3 and retain for your records. CENTRAL MALLET REGI'T f'i KIMBERLY AYE. STE 4:�sL'L s. Send COPY 2 to EPA. Rei ign,9 sun F or,f,.I%A%d,Lcp)MTXIXXXXX.. ., 3443 RQUTIER ;UAU u,PLACEitiTIo, *CA SACRA4FNTrsr CA 95827-1098 �-92670 YOUR REPORTING PERIOD IS AND YOUR REPORTS MUST BE SUBMITTED BY DAYS FOLLOWING THIS PERIOD. stare NPDES Permit t Yeo, Mo. Day Year Mo Day Code Number Year Mo. Da r1 Transaction Fac lily _ Year Month for �i'� Reporting yam: i �i 06 .. 13 Date form was sj� .rL� II L Code 6..D +L: ,-'t �i�..l I this report �lY Q Period Beginning �t t- Ending cam uter rioted STATION DESCRIPTION - +;-3 R-4 R-1 ` CONSTITUENT NAME j,{ :.� �'J UJ P14 PH t H 01 UNITS SAMPLE TYPE -_., a ,. 'fofEi.ts Ve" v8 i.'3AH 6YIt.d � FREQUENCY r_ v.,icF KL Y WFLKLY _ 9iyy�K1Y WEEKLY WEi:KLY 4 L K c_ MONTH DAY I / __ __ _-___________ __ __-____-_____ __ __-___-__-___ __ _____________ -- _________-_-_ __ _____________ __ _ __ _____________ - _ - - ____________ __ _____________ __ _____________ __ _____________ -- 3 -- ------------- -- ------------- -- ---------- -- -------------- -- -- ---- -- ------------- -- ------------- -- ------------- --------------------------------------------------------------- -------- -- ---- -- ------------- '-- ------------ -- ------------- -- -------- -- ------------ -- —--- - ---- -- ---- - --- -- ------------- lk- ---- -� -- -G' ---- -� - r --------------------------------------------------- -- ------------- -- ------------- -- -- ------------- -- ------------- -- ----------- -- ---------------------------------------- ------------- ------------------------------------- -------------------- ------------ - --------------------------------------------------- ------------- - -- !! -- ------------- -- ------ -- ------------- - ------------- -- ------------- -- ------------- -- ------------- -- ------------- - -- ------------------ - -------------- ---- 1 -5-1 ----�- 3 - -'- ---- , X ---- -! -----6=0— -� - - '�------z-------- ----�,�---- -1 - -7--7--- 1 ------7=`--- ---- -�--- --- -- ------------- -- ----- --------- -- ------------- -- ------------- -- ------------- ---- -- ------------- -- ------------- -- ---- �� -- ----------- - -- ------ -- ------------- --------------------- ----------- ------------------ --- --4---------- ------------------ -------------- --------------------- -------------------------------------------------------- --- - -- ---------- -- ------------ -- -------------- ------------------ -- ------------- -- ---------- ---- - ------------- --- ------------- -- ------------- -- ------------- -- ------------- -- ----------- -- ----- -- ------------- ---- ----�_ ---- ----- ---- -t -----6- - -� ---- '-z---- J ----��-g---- --------7r�---- -f ---- 7-7---- ----�' lQ --- -- -- ------ ------ -- ------------- ---- -- ' ------------- ------------------ -- ------------ ------------- ---- -- ------------- -- ------------- -- ---- -- ------------- ------------------------------------ - ---- -- ------------- -- ------------- -- -- - ------------- -- -------- -- --- ----------------------- r ---- ! -----7_-�---- -j -----G-�---- -L - ---� - -� ---- --------- ---- - ---- -! -----7 ---- -I ----- ---- -< ------------- Q ---- Ly -- ------------- -- ------------- -- --- ---- -- ------------ -- — ---------- ------------- -- ------------ — ------------------------- -------------- F ----- -- ------ w ---- -- ------------- -- ------------- -- ------------- — ------------- -- ------------- -h MONTHLY AVERAGE / U Y5 _ MONTHLY HIGH �6 �' :• MONTHLY LOW / . /j _.� T•l� --,� 7 7. TOTAL RECORDINGSr MO- 'Zt/ `- REQUIREMENT #1 Times Exceeded --4 �' REQUIREMENT #2 Times Exceeded REQUIREMENT #3 Times Exceeded !IC Enter number OI Samples TYPed Name of Pt mupal Exec trve Olhcer I certYy under penaltyI law that I hm-e Personally examined and am familiar with the information submit ted nth s document and all onodrments d that. basedonmy nqu ry of hose nd v duals m ted rely < �� j EPA token during the day. r / respons he for obta n ng the information I bel e.e that rh Iormaron is true c urine and camptete al am - - yr- 'viO- O COPY re that there are signlhcam penal)es for s.bmm n,false -nlormm on od,,d ng the possbil ty of fineS 9 inure of Pri a x cut v °y Lost Fnst MI and impnsonment gthc r Authorized Agent Date 1