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INSTRUCTIONS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD <br /> I. Remove COPY 4(dark yellow) and use for your worksheet. F <br /> 2. Use ballpoint pen or typewriter for data entry on forms. <br /> DISCHARGER SELF MONITORING REPORT �f <br /> 3. Provide doles for beginning and ending in reporting period blacks.,, ' Oi S• VEN RE.SORTS, INC. � <br /> 4. Provide data as specified under column headings. CALIFORNIA REGIONAL WATFR QUALITY 1TARAOISE POINT MARINA <br /> 5. Enter monthly summary data (MONTHLY AVERAGE. MONTHLY HIGH. etcL CONTROL BOARD <br /> 6. Appropriate signature is required at the bottom of thelfbrm <br /> 7. Remove COPY 3 and retain for your records, ., � . -� "' CENTRAL VALLEY REGION 711 We KIMBERLY AVE, STE 700 <br /> 8. Send COPY2r(tSC4l' YRX9iW)k9X9,P'XKAtX)(g("J(%WX'X9(XXXX 3443 ROUTIER ROAD 0'wPLACENTIA ,CA <br /> SACRAMENTO, CA 95827-3098 Fw92670 <br /> YOUR REPORTING PERIOD IS MONTHLY AND YOUR REPORTS MUST <br /> 5 <br /> BE SUBMITTED BY ! DAYS FOLLOWING THIS PERIOD. Stole NPDES Permit PAGF s <br /> Year Mo. Day Ye br Mo. Da Code Number Year Mo. Da <br /> 2 Transaction Facility Year Month for 97OQ Rep or lid 92 n? O1 Ending 92702729 Ob CA008T_3 coatuterarneed 97 01 28 <br /> L Code I LD. 5�13�I04I00 I this re port I Period Beginning g <br /> STATION DESCRIPTIONR-7 q-'} R-4 R-I R-2 R-3 R-4 <br /> CONSTITUENT NAME D J Ft p F I? D;; P11 PH P41 PM <br /> UNITS M MG/1 MG/L MG/L <br /> SAMPLE TYPE GRAD Gr;pn GRAB GRAB GRAB GRAB GRAB GRAB <br />( FREQUENCY WFFK Y WFFKLY WIFFKLY _ WFEKLY WFEKLY WEEKLY WEEKLY WEEKLY <br /> MONTH DAY * !'C J�C >f,' !JC i�C i�C 7�C <br /> Ste__ - ----------------------------------------- -------------------------------------- <br /> -- 3 -- ------------- -- -------- ------------- <br /> - <br /> y-- ----------------- --------------------------------- -------------------------------------------------------------------------------- -------------- <br /> ---------------------------- ---- ----------- -- ------------- <br /> ---- - -- ----- ---- -- -- <br /> - -- ---- - ---- - -- --- -- -- ---- --- <br /> ---- -- - ------ - -- --- <br /> ------- ----- -- - -� ----- ------- -- -�-' --- -! --------------------------`�----------------- ---------------- <br /> :7fir -`----- ---- ,y--- <br /> ---- ---------------------�- ------------- <br /> ---- -- ------------- - ------------- <br /> -- ------------- `-- ------------- - -- ------------- <br /> ------------------ ----------------- -- <br /> ---- �L -- ------------- -- ------------- ------ - <br /> ---- -- ------------- -- <br /> ---- 3 y -- ------------- -- ------------- ------------- <br /> 7 -- --------------------------------------------------- ---------------------------------------------------------------------------- ------------- <br /> ---- ------------------ -------------------------------------- <br /> --- -- ------------- - <br /> --- -- ------------- -- ------------- - <br /> ---- i9 -- ----------- -- <br /> ---- - --- -- --- ----------------- z� -- - -- -- ------------- <br /> ---- � -- ------------ - - - - - <br /> ---- z -- ------------ -- ------------- - <br /> ---- z -- ------------- -- ------------- <br /> ---- z3 -- -- ------------- <br /> ---- z� -- ------------- - ------------ <br /> - -- i -- ----- -- ------------- - <br /> H __ _____________ __ _____________ <br /> __ _____________ __ _____________ _____________ _ __ <br /> Y <br /> _____________ _____________ <br /> __. _____________ __ _____________ __ I <br /> W _—_— __ __ ______ __ ---------------------------------- <br />} MONTHLY AVERAGE /D • / 0. l 7 -7, y 7r 4 L•/ <br /> MONTHLY HIGH R. B l O / y 0 . 1 7• N 7, y 7. 44 -7- 14 <br /> MONTHLY LOW / / / D 1 7. 4 -7• L/ 7• q 7. y <br /> TOTAL RECORDINGS/MO. <br /> REQUIREMENT#1 <br /> Times.Exceeded � <br /> REQUIREMENT N2 <br /> Times Exceeded <br /> REQUIREMENT d3 <br /> Times Exceeded <br />* Enter number of samples Typed Name-1 Pian cip of Ex cul rve OlLcer 1 caddy u der penohy al low that have personally exon ned and am la mil wr wnh the inform anon subm,t / p <br /> "J ted int sndocumem and all onoahments and that based on my nqu ry of those individuals edimely - EPA <br /> taken during the cloy. 4`.i ` r�/C� responsible for bl• q the ialmmot on I believe(hat the' forma on is true. ccrote and campptele am yr. Mo. D <br /> aware that there e j," cart penah es to,submit ng false 'ofmomli n. d.ding the pass b'lity of fine ( Signature of mapal ¢cu v ( ,OPY <br /> ran..01-e ra last <br /> First MI and'mpr son mens. Olhcer or Authorized Age Dote <br /> _--_—--- --.---- --!__—_---—_---- __—______ _-------.___—___—__ <br />