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wsrpucnc FOR entry <br /> aIARGER CALIFORNIA STATE WATER RESOURCES CONTR <br /> t. Remove COPY 4 (dark yellow) and use for your worksheet. <br /> 2. Use ballpoint pen a typewriter for data entry on forms. DISCHARGER SELF M BOARD <br /> 3. Provide dates for beginning and endingin d ortin ONITORING REPORT <br /> p g period blocks. <br /> 4. Provide data as specified under column headings. ua .�.R ACY °` � I <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). t..A�.1Ff1Rt�E4. 'tEGjDAt 6dA TER. + tJAI..I-�'� • �.YTY r-' i <br /> 6. Appropriate signature is requiream for yd at the bottom of the form. Cl`tN�' � POAO LLz TRACY STP I <br /> 8. Send COPYI)646QX,k7. Remove COPY 3 and f�6Yol( , So�dur r }slLoSdGY �f9Q�fnXXX.K'1Pf�f# <br /> C.�iTRAl. VALLEY REGION <br /> 3n 1 S STREET PD eox 1029 <br /> YOUR REPORTING PERIOD IS M?O^i'Tf�L-Y SACRAMENTS* CA 95818 zw TRACY CALIF <br /> C�AND YOUR REPORTS MUST ao `°' 7Et <br /> BE SUBMITTED BY 0 DAYS FOLLOWING THIS PERIOD. F` <br /> i. TraCodeion Fac t Year Mo. DayState N <br /> Q?I ad Y a t y Year Month for Year Mo. Da Code Number <br /> STATION <br /> I D � t r i I this report Reporting y <br /> Per od Beginning y` c} Ending �9 (.'# 06 a form was <br /> STATION DESCRIPTION ,. <br /> i} � Dat YearMo. Day <br /> computer printed <br /> wyr <br /> SAMPLE TYPE <br /> FREQUENCY <br /> MONTH DAY liSyt, . ,yp. a �, �N rA ,, r ✓ tir, <br /> z "Xb <br /> > <br /> _ <br /> 4 1 <br /> .3� r.,.p.•.' Cn nom+�"+ ----------- <br /> - <br /> --- yN <br /> 4 m = <br /> rt L if %LzZ <br /> r ) <br /> t.LL:.,. .c2 ` f✓F n<-.. : ••, ti <br /> w _ <br /> st '" '. —_- __-- —_-- _ --_ <br /> w — <br /> { <br /> --- �`-� s _— r <br /> — — ,.r <br /> 0 <br /> aO y -- 77 <br /> L <br /> �rh �� <br /> 7— 777.Y <br /> - yIC _ <br /> '-'' { . <br /> ic' <br /> Q< _ .a.h�y fmf,i"4. Lu — `' 'yW �� ����` � L"✓.%X�..q .rd ��' ' <br /> -- <br /> t MONTHLY AVERAGE " <br /> 9; 17 MONTHLY HIGH i <br /> -- <br /> MONTHLY LOW 6 X20 c� Qr <br /> TOTAL RECORDINGS/MO. Z <br /> REQUIREMENT #1 <br /> REQUIREMENT #2 <br /> Times Exceeded <br /> REQUIREMENT <br /> Times Exceeded {_ •'N ;tiz� <br /> '.Enter number of samples Typed Name of Principal Execu rive Officer '"`` z ' { "' <br /> taken during the day. <br /> Scott PdY^1^E� the <br /> I declare under penalty of penury that the foregoing is true and accurate, and that 1 <br /> the sampling procedure and ana ys"s used for t e colum <br /> Form 029/]4 n constituents was as spec <br /> L <br /> First MI fled in t e Waste Discharge Order for this facility. <br /> ,.., S9tft re er P p I F ec r e Yr. Mo. Do, COPY <br /> rized Agent <br /> Date <br />