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' T INSTRUCTIQ , FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTRO_ BOARD <br /> 1. Remove COPY 4 (dark yellow) and use for your worksheet. DISCHARGER SELF MONITORING REPORT a j Acr, ciTv . <br /> ! 2. Use ballpoint pen or typewriter for data entry on forms. <br /> 3. Provide dates for beginning and ending in reporting period blocks. r 9L,LF':IR"V IA $E S10NA:L. 4Al EP, 4UAL.X T Y LLZ TRACY t.TP <br /> 4. Provide data as specified under column headings. <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). cO=�r,R,Oe; BOARD <br /> 6. Appropriate signature is required at the bottom of the form. CENTRAL. VALLEY REG 10N PCI BOX 1029 <br /> 7. Remove COPY 3 and retain for your records. a 5jrgq`C-ET ip jf{AC1P CALIF <br /> B. Send COPY IX X;We'�Xo1SIlI,76 [F�fdb2�sNd4AX$ 1( XXfN <br /> .SACRA"ENTOt CA 05F16 Qo95376 <br /> MDfNTNLY �< <br /> YOUR REPORT NG PERIOD IS��AND YOUR REPORTS MUST PAGE <br /> BE SUBMITTED BY ® DAYS FOLLOWING THIS PERIOD. State Numb Permit <br /> Year Mo. Day Year Mo. Day Code Number Year Ma. Day <br /> Year Month for Re orcin Date form was <br /> Transaction facility i ^7e '1 e g Beginning 79 Alt ti. Ending79 {}4 "} ' �6 LT C67 Y'.*;6 computer printed �`$ C9 �'L.$ <br /> — Code I D. Bf 39t) �$ this 'report /( r / Per'od g 9 <br /> .STATION DESCRIPTION r <br /> CONSTITUENT NAMEU. ``°,vh ,., <br /> SAMPLE TYPE <br /> FREQUENCY <br /> � MONT0C4JO0 <br /> Z---- ----------- <br /> b ----� ---- --Q----- -Qs - -- ----- <br /> -- -- — <br /> .3- <br /> L80 a3 21 <br /> --- 6 - 1 i4 70 6,$ 5 _ f O Ti'a o -- - <br /> - <br /> --- 7- <br /> ---61, 6 <br /> --- 1 Z,3 <br /> - - ---- -- <br /> --- <br /> [� li2 6� ' vat c <br /> 77, <br /> a^ <br /> c- <br /> --- 5nf"M`rs!-*n ✓ F, <br /> ---- <br /> ig 07 X6/3 b, 6317 77,71 <br /> z n 1 <br /> a <br /> 1� <br /> --- IMP- <br /> _ � MY.."}i H+^`f*'�'.`�. �kHMpk`/ €�L��� �.4� .ir' '•wYW4Wi'Sef�✓A�Sa41� f+4. �%_ Y.SJYf 'itx �;"`YMT`}e.165 hv5^f+^'?*W{wWh^ff'r44kxr4�'+.4. t4n4MY+'�i4.e�e_Y li�h' 3y <br /> f J <br /> a Sa 7 / �)Y <br /> L€a�_� <br /> -- <br /> / v -6 - - ----------- <br /> ---------- - - -- - -- -- -- — ---- <br /> -- --- - ----- <br /> p S, <br /> tMONTHLY AVERAGE / 3 /.O 6,74 <br /> MONTHLY HIGH /a- 01 'ag `o7 <br /> MONTHLY LOW r ;A& O <br /> TOTAL RECORDINGS/MO. C) 3 <br /> REQUIREMENT #f "u5�" " , �a� `say h�.x. � � �a <br /> a <br /> 4 <br /> Times Exceeded <br /> •REQUIREMENT #2 %;r yp$ g.'T lw`'� t z .rf'° :`v✓�vd hu` � ,t ��'`r z o yr ,ems <br /> ' Times Exceeded <br /> 1 REQUIREMENT #3 mFs„s H€t <br /> Times Exceeded <br /> *Enter number of samples Typed Name of Principal Executive officer �✓ ) 2JI p idtd Phot i 'taken during the day. SCO'tt Darrell the sampling procedure and analysis used forihe columnconstituents was as speci- S nut reof Fr nr pol Executive LTC 1yr Mo. DayCOPYForm Q2-9/74Last First MI flied in the astescargerer;ory. riff cer or A thorized Ag t Date <br />