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`— INSTRUC AS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES.CONTROL BOARD i I. Remove COPY d (dark yellow) and use for your worksheet. 2. Use ballpoint pen or typewriter for data entry on farms. DISCHARGER SELF MONITORING REPORTS Rf_SORTSo INC, 3. Provide dotes for beginning and ending in reporting period blacks. I FORN IA REGIONAL NATER QUALITY <z ARAD ISE POINT MAX INA J. Provide data as specified under column headings. 5. Enter monthly summary data (MONTHLY AVERAGE. MONTHLY HIGH. etc.). CONTROL BOARD 6. Appropriate signature is required at the bottom of the form. CENTRAL VALLEY REGION II W* KIMBEvLY AVE, SIL 20v 7. Remove COPY 3 and retain for your records. 18. Send COPY.0,fo,EPA,Aeg1oA.aAcYr &A4st VAcK2M4,X?6XXXXX XXX 3443 ROUTIER ROAD LACENTIA SCA SACRAMENTO. CA 95827-3098 =g32670 YOUR REPORTING PERIOD IS `I ` AND YOUR REPORTS MUST BE SUBMITTED BY DAYS FOLLOWING THIS PERIOD. State NPDES Permit PAGE it# t I Year Mo. Day Year Mo. Day Code Number Year Mo, Do 2 Transaction Facilo v A I I Year Month for �/ Re orcin QZ IBJ I 2 t 1 AC 13823 Date form was 2 J(T 1 Code I LD, y � 4, t/« I his report LTJ I Perlodg Beginning Ending Ob computer rioted STATION DESCRIPTION -1 R-? R-3 -4 � CONSTITUENT NAME TUr8101ry TOR811)1TY TUPdIUITY TUkdI0ITY1 tral C R A fUrx E APERATURE T r. MP[:IR it I UkhERPERA UNITS -litu TU JTU DEG F(C DEC) •3FG E(C DEG) -EG F(C DEG) DEC F(C DEG) SAMPLE TYPE GRAB GRAB GRAB GRAB - RA 5 FREQUENCY WEr LY WfEf (LY Wa- KLY WEEKLY ifEEKLY wF MONTH DAY *'. !�C >]C J�C !�C * * �C� ---- a -- ------------- -- ------------- -- ------------- -- ------------ -- ------------- -- ------------- -- ------------- -- ----------------- -- ------------- -- ------------- -- ------------- -- ------------- -- -- -- ------------ -- ------------- -- ------------- ---- -- ------------- -- ------------- -- ------------- -- ------------- -- ------------- -- ------------ -- ------------- -- ------------- ---- -- --- -- -- ---- - ------ ---- -- ---- �i / C-- ------i ---7 o---- -� -- a-- --77'----- -7 ---a---- ---- -- ------------- -- ------------- ------------- -- 1j -- ------------- -- ------------- -- ------------- ---- 7- -- ------------- -- ------------- -- ------------- ---- ------ ---- -- ------------- -- ------------- ---- » -- ------------- -- ------------- -- ------------- ---- -- ------ ------ -- ------------- -- ------------ ---------- ---- -- ---- ----�,6----- --------j ---1:7---- -� -----�-�--- -� -----�.�-�--- -� --7�n------- -7 --7V,------- j --Jia------- � -��r------ i - - --------- -- ------------- ------------------------------------------------------------- ------------ ----------------------- -------------- ---- �� ------------- ------------------- -- ------------ -- ------------- -- ------------- -- ---------- --- ----------------------------------------- ------------- ---- -- ------------- -- ------------- -- ------- ----- -- ------------- -- ------------ -- ------------- ----------------------- ------------- -- ----------- -- ------- ----- -- -- -- -------------------------------------------------------- ---- -------------- -- ------------- ---- -- ------------- --------------------------------------------------------- ------------------------------------------------------------ ------------- ---- �- -- ---- --- - /"---- -j -------- T---------- -7G o------- -� =j�-,-------- --- ------- ---- re -- ------------- ------------------------------------------ ------------------ ------------ ---- -- ------------- -- ------------- -- ------------- - ----------'--- -- ----------------------- ------------- -------------- -- ------------- ------------- ------------------ ------------------ -- --------------------------------------------------- ----------------------- ------------- -43 ------------- ------------- -- ------------- -- ------------- -- ------------- ------------- ------------- -- -- -- -- -------- ---- -- ------------------------------- z _ _ - �,------- -�------------------------------------------ -------'----- -� `TG'r------- r 7 -------- 7b- ------- '77a------- 'N __ __ _____________ __ ___ _____________ __ -------------------------------------------------------- < ______ __ _____________ __ _____ __ ____ J _________ __ _____________ Q ____ __ _____________ __ -- __ -_-__________ __ _____________ __ - - ----------------- ____________ -------------- t I� ____ __ _____________ __ _____________ —_ __________--_ ----- ----------- __________ _____________ t MONTHLY AVERAGE 01 77,j MONTHLY HIGH !o O O. XfJ MONTHLY LOW 0, S 0-v 7 --7375- 77 TOTAL RECORDINGS/MO. < < c ( n REQUIREMENT N1 Times Exceeded - REQUIREMENT U2 Times Exceeded REQUIREMENT #3 Times Exceeded zt, Enter number of samples Typed Nome of Pilnclpol Ex C rive Olhcer I ceruly u der penohyoof law Ihol I ho.e uersonully exorn ned and am fomllmr nnh the formation submit ,'T T P ted 'n t ndocum.nt nd all mtachme t!z a td shot. based on my rqu ry of those nd✓duolz ediotely C� pc (,3 /EEP^A I'� taken during the day, zf/�' y respons ble for obto n ng the nlormot on I bel a+e that the inlormat on s true accurate and camptete am COPY (� ow that !here ore sran'1 met penoluus for subnYI ng false 'nlormat on. nclud'ng the poss'b I ty of fine Si nature o - cipal xecun Yr. Mo. Day Form a19 p last First MI and iro rsonmenl. p 11lcar or Aulhorized Agent Dale