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RECEIVE® <br /> JAN 2 9 2014 <br /> Monitoring Report Submittal Transmittal Form <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Attn: Brendan Kenny(916)464-4635 <br /> Central Valley Regional Water Quality Control Board <br /> 11020 Sun Center Drive#200 <br /> Rancho Cordova, CA 95670-6114 <br /> Discharger: Newport Paclflc Capital Co., Inc. <br /> Name of Facility: Arbor Mobile Home Park WTF <br /> WDRs Order Number: 03-099 <br /> WDI D: 51339NC00020 <br /> County, San Joaquin <br /> I am hereby submitting to the Central Valley Water Board the following information: <br /> Check all that apply: <br /> Monthly Monitoring Report for the month of <br /> 1 st/2nd/3rd l 4th(circle one)Quarterly Monitoring Report for the year of. <br /> 1 st/2nd(circle one) Seml-annual Monitoring Report for the year <br /> Annual Monitoring Report for the year <br /> Vlolatign Notification <br /> During the monitoring period,there were/ �ere not(circle one) any violations of the WDRs, <br /> 1. The violations were: <br /> 2. Have the violations been corrected? Yes/ No. If no, what will be done to correct the <br /> violations: 1(k <br /> Certification Statement <br /> "1 certify under penalty of law that l have personally examined and am familiar with the <br /> information submitted in this document and all attachments and that, based on my inquiry of <br /> those individuals immediately responsible for obtaining the information, I believe that the <br /> information is true, accurate, and complete. 1 am aware that there are significant penalties for <br /> submitting false information, including the possibility of fine and imprisonment." <br /> 6 <br /> Signature: ... Phone: <br /> Printed Name: !" W�f Date: r, <br /> 14�:XL< <br />