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— — — —. — —--, —.-, —.—, <br /> I <br /> INSTRUCTIONS FOR 'HARGER CALIFORNIA STATE WATER RESOURCES CONTROL { \RD { <br /> T. Remove COPY 4 {dark yellow) and panniertypewritera your worksheet. DISCHARGER SELF MONITORING REPORT <br /> 2. Use ballpoint peor Typewriter for dolo entry on loans. -F SEVEN RF.SORTS 0 INC. <br /> 1 I I Provide dal as for beginning and ending in reporting period blocks. CALIFORNIA REGIONAL HATER QUALITY LL=PARADISE POINI 14ARINA <br /> 4. Provide data as specified under column headings. <br /> 5. Enter mornh y summory data (MONTHLY AVERAGE. MONTHLY HIGH. etc.). CONTROL 813AND <br /> 6. Appropriate signature is required at the bottom of the form. CENTRAL VALLEY REGION 71 l h'• K IH13ERL Y AVT:* 51E 200 <br /> 7. Remove Co "rRp <br /> 8. Send COPY <br /> XXXXXXriX 3443 RUUiIER tUAU uIdCENTIA rCA„ <br /> SACRAMFNTQ• CA 95827-3098 2670 <br /> + YOUR REPORTINGPE ISD ISAND YOUR REPORTS MUST FACE -Jj <br /> BE SUBMITTED BY u DAYS FOLLOWING THIS PERIOD. slate NPDES Permit <br /> Year Mo. Day Year Mo. Day Code Number Year Mo. Da' <br /> 2 Transaction Facility I04I Year Month for m Repaint S9 <br /> Q 34 1 90 4 Q �6 0082376 Dote form was 9C Q3 23 <br /> Code I LD. L this report I Period Beginning Ending I computer printed <br /> STATION DESCRIPTION if <br /> CONSTITUENT NAME DO U ' ULU rT t r ' <br /> UNITS 4G/L MG/l ;1;/11- wG/L <br /> SAMPLE TYPE A til ' NA 0 T7F ii t'X- A ' �'"�' �- GRAB <br /> — <br /> FREQUENCYWitt-KILT !iii.. - _ - <br /> MONTH DAY !�'. 7�C t- <br /> C * J�t: <br /> 1 <br /> - -- - ----------------------------------------- <br /> -- ------------- -- ------------- -- ------------- -- ------ <br /> 1 ---- -- -------------------------- -- -------- -- -- ------------- -- ------------- -- ------------- -- ------------- -- ------------- <br /> j - ------------ - -------------- ------------- <br /> -- ------------------- <br /> ------------ <br /> ---- ------------------ -- ------------- -- ------------- - ------------- -- ------------- -- - -- <br /> ---- - •-- ------------- --------- -------- -- ------------- -- ------------- -- -------- ---- ----- -- ----------- - ------------- <br /> --------------------------- <br /> ------------ <br /> `5 -- ------------- -- ----�------- -- ------------- -- ----------- -- ------------ -- ------------- ---------- - <br /> y �' t -------- ---- — ------------------ ------------- <br /> 7- --------- ----------- <br /> Il --- - -- ------------- -- ----------- -- ---------- - -- ------------ — <br /> ------------- -- ------------- -- -- ------------ ------------------ <br /> ------------------ <br /> -- ------------- <br /> ------ <br /> ------------ <br /> ---- �- -- ------------- -- ------------- -- --- ------------- - ------------- <br /> n) ------ ------------- -———------------------------------ ------------- <br /> ------------------------------------------- <br /> ------------ <br /> -- — ------------- -- ------------- -- ------------- - ------ - -- <br /> ---- - -- ------------- -- ------------- -- <br /> / <br /> �'- ---------- ------------- <br /> ------------------- <br /> ---------- <br /> --- -- ------------- -- ------------- -- <br /> ---- -'- -- ------------- ------------ -- ------------- -- ------------- -- ------------- -- ------------- -- ------------- --- ------------- <br /> ----------L <br /> - ------------- <br /> - -- ---L Q------------------LO ------------------0------ -- ----I-D--------------------------------------------- ----------------------- ------------- <br /> 17--------------------------------------- ----------------- . <br /> -------------- <br /> ---------------- <br /> - -- ------------- <br /> ------------------- -- -- ------------- -- ------------ -- ------------- -- --- -- ------------- -- ------------- <br /> ----- --- --- ------------- -- ------------- -- ------------- -- ------------- -- ------------- ----------------------- <br /> ' ---- -`� -- ------------- -- -------------- - ------------- <br /> -------------------- <br /> ------------ <br /> -- ----------- - -- ------------- -- -- ------------------ --------------------------------- -- ------------- --- ------------- <br /> ------------ - <br /> ------ <br /> - ---- <br /> `-� -- ------------- _ <br /> ---- �3 <br /> -- ------------- -- ------------- -- ------------- -- -------------- -- ------------- -- ------------ -- ------------ <br /> � __ _____________ __ ------------- __ . <br /> I/ <br /> __ _____________ __ _____________ __ <br /> Z-h __ _____________ --------- <br /> __ _____________ __ _____________ __ ___--__—_____ __ _______—_____ __ _____________ __ _—__ <br /> 7 — -- -- <br /> y _ _ _______ <br /> __ _____________ __ _____________ ___ _____________ __ _____________ __ _____________ __ _ <br /> _—__ <br /> f + MONTHLY AVERAGE ,t „ / ' 0 S, 0 S. 0 S. OR-FRA 41 <br /> MONTHLY HIGH <br /> MONTHLY LOW <br /> TOTAL RECORDINGS/MO. _ <br /> REQUIREMENT N1 <br /> —T1 m-es Exceeded <br /> ' REQUIREMENT N2 <br /> Times Exceeded _ <br /> REQUIREMENT#3 <br /> I Times Exceeded <br /> SIC Enter number of samples IYPed Name al Principe Executive Olhcer I cer .. under penally of law that I have personoll examined aad am lamrhar n h rhe rnlormairon b-.1 <br /> u ted rn ih ndocum enc and all a�b chin encs and Thor based on my nqu ry of chase nd duals sd io rely - o EPA n <br /> n <br /> taken during the day. responsblelov obtaining the information Ibele+eihoi rhe information is true occurs ie and co plei e. am a L <br /> aware rhos there ore s god wnr pen olr es for mbm n ng la lse n format on nclud ng rhe pass 61 ry of lion n uic ri x c�i We' COPY <br /> roan qav vn Easr first MI and im pr t here L' Ilicer or orized gent Date <br />