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INS_TRUC IS FOR DISCHARGER ( CALIFORNIA STATE WATER RESOURCES CONTROL BOARD <br />,,. Remove COPY 4 (dark typewriter <br /> and use for try n forms. DISCHARGER SELF MONITORING REPORT = <br /> 3. Use ballpoint pen a typewriter ler data entry of loans. SF..VEN RESORTS INC* <br /> i 3. Provide dales for beginning and ending in reporting period blocks. uZ <br /> Ia. Provide data asspecdledunder column headings. CALIFORNIA REGIONAL WATER QUALITY PARADISE POINT MARINA <br /> 5. Enter monthly summary data (MONTHLY AVERAGE. MONTHLY HIGH. etc). CONTROL BOARD <br /> J6. Appropriate signature is required at The bottom of the form. <br />.7. Remove COPY 3 and retain for your records. CFNTRAL VALLEY REGION 7I1 v:• KIMBERLY AVI:� STE 200 <br /> 8. SendCOPY PLdCFNTIA .CAR ) �ok9xf9 <br /> SACRAHENTOt CA 95827-4098 ao 92670 <br /> YOUR REPORTING PERIOD IS M MTHLY AND YOUR REPORTS MUST F` <br /> BE SUBMITTED BY L15 DAYS FOLLOWING THIS PERIOD. state NPDES Permit PAGE <br /> Year Mo. Day Year Mo. Day Code Number Year Mo. Da <br /> Transaction Facil it Year Month for Reporting L Date loan was <br /> 2 Code I LD y L his report )PJ /)`n I Period Beginning 9 0 0i Ending f 3 N's 11 OV CA00623 om uler rioted 9Z 12 14 <br /> STATION DESCRIPTION ,- <br /> CONSTITUENTNAME TOT COLIFORi4 TOT CGLTFORid TOT CJLIFOR-4 TOT COLIFORM <br /> UNITS • of I , !e, - <br /> SAMPLE TYPE r, CvT <br /> FREQUENCYr. ' .• <br /> MONTH DAV �C * * I I I <br /> -_ <br /> ______------- ________ <br /> __ ---___---____ __ _____________ <br /> __ _____________ _____________ <br /> __ __ _____________ <br /> _____________ __ _____ <br /> ________ __ ___ _ __ _____________ <br /> - __ _____________ __ __—_-_____-_ __ _ __-__________ <br /> & <br /> __ ---___ __ _____________ __ _ <br /> _ _ _____________ __ _ <br /> _� ___� _______ L/ ____7/-6 DD _ _� 7 _____________ __ _____________ __ ______ _ <br /> -- -- -- ------------- ------------------------ -------------------- ------------ -- -------------- <br /> ----- ------------------ <br /> ---- ------------- <br /> ---- -- ------------- -- ------------- ----- ----------- <br /> -- ------------- -- ------------- -- ------------- -- ------------- -- ------- - -- - - <br /> ---- ----------------- -- ------------- ------------------ ------ - ------------- -- ---—------------------------------ ------------- <br /> --- L_/ -- ------------- -- ------------- -- ------------- -- ------------- -- ------------- -- ------------- ----------------------- ------------- <br /> ---- /3�-------------------------------------------------------- <br /> -- ------------- -- ------------- -- -- ------------- -- ------------- <br /> /S <br /> ---- ----------------------------------------------------------- <br /> - -- ------------- -- ------------- <br /> --- -- -- ------------- -- ------------- -- ------------- -- ------------- ------------------------------------------------------------ ------------- <br /> ---- M6 -- ------------- -- ------------- -- ------------ -- ------------- -- ------------ -- ------------- -- ------------- -- ----------- <br /> --- -Z -- ------------- ------------------------------------ -- ------------- -- -- -- -------------- ----------- <br /> ------------- ------------- -- - - <br /> ---- �- ----------------- -- <br /> --- /> ------------- -- ------------- -- ------------- -- ------------- <br /> -- ------------- --- ------------- -- ------------- -- ------------- -- <br /> ---- e2 -- ------------- -- <br /> -------- ----------------- <br /> ---- -- ------ ---- -- ------------- -- ------------ -- ------------- -- ------------- -- ------------- <br /> ---- ev / oa----- --' ----- QD--- / --p%".�0 --- - ------------- -- ------------- -- ----------- <br /> zz <br /> ---- -- ------------- ---- -------------------------------------- ------------- ------------------------------------------------------------ -------------- <br /> ------------------ ----------------------------------------- <br /> Z_5 -- ------------- ----------------- <br /> -- - -- ------------- -- ------------- -- -------------- ------------------ -- ------------- --- ------------- <br /> ---- Z7 -- ------------- -- ------------- -- ------------- <br /> - -- ------------- -- <br /> ---- <br /> Y <br /> --------------------- <br /> -------------- <br /> --- _____________ __ <br /> _________ __ __________ <br />+ MONTHLY AVERAGE </ ! 1 166 <br /> MONTHLY HIGH / 60 00 00 <br /> MONTHLY LOW -500 Z N O UO <br /> TOTAL RECORDINGS/MO. 3 3 <br /> REQUIREMENT N1 <br /> Times Exceeded - <br />?EQUIREMENT #2 <br /> Times Exceeded <br /> QEQUIREMENT N3 <br /> Times Exceeded _ / <br /> Ik Enter number of samples Typed Name of Pi mclpal Ez culive Olbcer I cenilyy u der penally of law that I ha.e uer Ily ,.om ned and a I d or w th the for t on ubm t ,( ~�/Jp EPA <br /> led u, th sndocumeN a d all avoehments a.d Thal based on my bq y o1 those nd v'duols ed blely / / .l z <br /> taken during the day. / - respons ble for obtaining Ih,inlormol on I bel eve than the la mato ,,vue accurate and co ppie to I pm - COPY <br /> owore that there are signTYont penoll e.for sub s n ng false information mduding the possblllty of fine Sig azure o1 rind xecufiv Yr. M. Day <br /> ro. OP_c )a <br /> Los First m a rid'mprisonmenL Cglli<er or A tzed Agent. Date t <br />