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INSTRJ NS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD 1, Remove COPY 4 (dark yellow) and use for your worksheet. F 14. Use ballpoint pen or typewriter for data entry on farm= DISCHARGER SELF MONITORING REPORT FSEVEN RE;SCJRTS. INCe, 3. Provide dates for beginning and ending in reporting period blacks. u< ❑4 4. Provide data as specified under column headings. CALIFORNIA REGIONAL WATER QUALITY <z ARADISE PULyT MARINA�.5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH. etc). CONTROL BOARD 'b. Appropriate signature Is required of the s. l the form. CENTRAL VALLEY REGION 711 H• KIMBERLY AVEs STE 200 7. Remove COPY 3 and retain for your records. ' B. Send COPY�K` Cj�(Kr+y��Qr�'r�z'N°cj(;�Fr r',t.� FP9(d Y(Q(I .XiIxXX 3443 RUUTIER ROAD H LACENTIA .CA :� • . „ SACRAM NTU• CA 95327-3098 as 92670 YOUR REPORTING PERIOb IS ; TH AND YOUR REPORTS MUST f< VAGE BE SUBMITTED l 'BY DAYS 4'L(IV ING THIS PERIOD. State NPDES Permit y- t Year Mo. Day Year Mo. Day Code Number Year Mo. Do 21 Transaction Facility Year Month for Rep or ling } Dale lorm was 7 Code I.D S`ti '.;4IOQ I his report � I Period Beginning 92 03 U1 Ending 92 08 JI 06 CA008d3 camp,ser rioted 9' 7b II STATION DESCRIPTION F'-- R-4 CONSTITUENT NAME T[{T COLIFORM Tor COLIFO?ra TOT COLIFORM TOT COLIFORM UNITS p, E o - ! f(UML RPt 'L! NL S'PNIIUGML SAMPLE TYPE r•r t- - GRAB GRAB FREQUENCYt -k _ WEiL.KLY __ MONTH DAY S�C * * 7�G Q_ 1------------------------ _ __ _____ __ ________ _____________ __ -------------------------------------------------------- _ ______ __ ________-__-_ _ __ _____________ • -_ __-__________ __ _____________ __ _____________ __ _________-___ __ _—_____—___ __ ____-______ -_ _____________ ____ >5--------------------- ------_----------------------------- __-__------------ ------------- ---- -- ------------- - ------------- -- ------------- -- ------------- -- ------------- -- ---------- -- - -- - --- ----- -------- --- -- ------------- - ----- -- ---- ------------ -- ------------- ------------ ---------------------------------- ------------ - ------------- -- ------------- ---- ------------- -- ------------- ---------- - ------------ -- ---—------ -- ------------------ ------------- -- ------------- -- -- ---- - -- ------------- ------------- ---- -- ------------- -- ------------- -- ----------------------- ------------- ---- -� 1- -- --- -E --- acJ------/--------� ---- -` -----/-3='--- -- ----------- -- ------------- -- ------------- ---- -Ly -- - ------------- -- -------------- -- ------------- -- ------------- -- - --- e ------------- -- ------------- - ------------- -- ------------- ----------------------- ------------- ---- 11i ------------- ----------------------------- — -- ----- -- ----- -- ------------- -- ------------- -- ------------- ----------------------- ------------- --- ,7 -- ------------- -- ---- -- ------------- -- ------------- -- ------------ - ------------- -- ------------- -- --- ------- ---- - ------------- --- ------------- -- ------------- -- ------------- ------------------------------------------------------------ -- ' --- ' s- -----«------ -'- -----Y=�--------� ----J-�Q. - I - - -J Z Q---- -- ------------- -- ------------- -- ------------- -- ----------------------- - ---- -- ------------- ------------------------------------------ ------------- -- ------------- -- ------------- -- ------------- -- ------------- ---- - ----- ------------- ------------------ -- ------------- -- -------------------------------- ----------------- ---------------------- -------------- ------------------5 -- ------------- G -------------------------------------------------------- - ------------ - ------------- -- ------------- -- -- ------------- -- ------------- ---- - -- ------------- -- ------------- ---- - 1- ------------- -I ------------- --I __ _____________ ___ __ ----_—_______ __ ________—____ —_ _______—____— ` __ _____________ __ _____________ ---------------- -------------- _ _----_____ __ _____________ _____________ Is + MONTHLY AVERAGE / Q MONTHLY HIGH > / 00 MONTHLY LOW FOTAL RECORDINGS:MO. #f 5 3 2EQUIREMENT Nl Times Exceeded - ZEQUIREMENT H2 Times Exceeded MQUIREMENT N3 L Times Exceeded p Enter number Of samples Typed Name of Pnnclpal EK curve OII¢er I ceruly under penalty I low the have yersenaly a amrned andam laminar with the inlormal�on submit ted in t ndocument and all oiler eNs and th al baa don my mgwry al tha se and wid vols a edi tell , ' e ✓ ^EP^A taken during the day. �' ,-spans ble for obtaining the mlormonon babew ih at the information is true accurate and complete am WPY aware that there are significant penalties for subrnrlung false information mciudlng the passib 11 ity of fin- 5 gra wre of P E ecutiv Yi. Mo. Day W ro rm oa v ya lost First MI and imp nsonm enl.' �Olfic er or Aur mized Agent. Dole