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CALIFORNIA STATE WATER RESOURCES CONTROL BOAL F <br /> INSTRUCTIONSFORDISCHARGER DISCHARGER SELF MONITORING REPORT < .� A ,,' CITY. . r,,.:. <br /> ellow and use for your worksheet a` p,,f.,lr LL� FRACY STP <br /> 1. Remove COPY 4 (dark yewriter for data entry on foorms.iod blocks. <br /> p, Use ballpoint pen or typewriter <br /> ending in re ortin p ("!N R'-L <br /> 3, Provide dates for beginning MONTHLY HIGH, etc.). Pq- BOX 1029 <br /> q, Provide data as specified under column headings. FTP.RL VALL-EY r�.E C�+�"7.y iw TRACY CALIF <br /> 5; Enter monthly summary data (MONTHLY AVERAGE, � '), C Sl REE,[,. <br /> b, gppropriate signature is required at the bottom of The form. , S Atr&' ' T�"� A �'>R .G ¢0 95376 f <br /> 7. Remove COPY 3 and retain fort your Fa <br /> g; Send COPY Z toE4YS, � 76 State NPDES Permit P'A'GE <br /> aCNTHLY AND YOUR REPORTS MUST Year Mo. Day Code Number Year Mo. Day <br /> YOUR REPORTING PERIOD ISWI Year Mo. Day Date form was <br /> BE SUBMITTED BY 15 DAYS FOLLOWING THIS PERIOD. Reporting <br /> Ending '7`� ¢,3 .'.ST �6 -«r154 omputer printed 73 i'$ �8 <br /> c <br /> Year/Month for ^Tp I Period: Beginnin �Sf +" ``T <br /> Facility <br /> r•t�7.+3£5 u'1 I this report // .g" <br /> Transaction LD y s �� <br /> �i 2 Code <br /> Qa <br /> STATION DESCRIPTION' I <br /> CONSTITUENT NAME UNITS <br /> SAMPLE TYPE 7r 99 L e <br /> C�0' ltf jo lam/ a t t <br /> NCY 50(15L1 �SZ <br /> FREQUE par / 7 "2 <br /> 1—?— +� <br /> --- � _ .� f._ 1 c3 "� 4n t I ,,�pyr�"Msl `^ i����+�t"�.,�.,. '�•',_'�'�,.�.ux .:� _.�_, "".`db `' _'+ y�y���. ,rr^'^�"- •:>�� LLQ � �. <br /> 2— J <br /> --- ®7 o4X41 <br /> R £Y rl4 r rt�i+F3�rz4F k+ W i LL+ ,.�. 1_' >f"Y <br /> 1 ----- - - - _ ---- 't ---- �' ? - -- - <br /> 13 Kv <br /> °� ( <br /> -- y077- s <br /> J �z i9. A'+xuefM* .,,. ,7 <br /> 7777,7 <br /> x � <br /> r � <br /> -- ----- -- -- - - -- <br /> �e <br /> <G1L� <br /> �a. ?fJ.� ,>•.. 47 f t `' 7 " eX+"»� u� ,,yl zu » <br /> {�LI- <br /> a3 <br /> 357 L7 I <br /> --- --- all Ss S� <br /> r,7 ...env y4,7 sy g �i4gr's£ <br /> "FsdM�»` <br /> -� - .s2 - - - - - -- �_ �- <br /> Y a <br /> A-1--7- --1�� - --- - - --- - -� -- -- <br /> a ---�o3y <br /> Q --- x_0011-- ---- <br /> w --- �� Ea. -- 3106 / <br /> ra+ MONTHLY AVERAGsE � 3� 2 3 <br /> MONTHLY HIGH a 2- <br /> MONTHLY <br /> MONTHLY LOW 3U ao <br /> O. <br /> TOTAL RECORDINGS/M <br /> REQUIREMENT #f <br /> Times Exceeded wse' <br /> REQUIREMENT #z <br /> Times Exceeded <br /> REQUIREMENT #3 <br /> r� Times Exceeded I declare under penalty of perjury thing is true and accurate, and that <br /> Typed Name of Principal Executive Officer 1 h 5 ture of P nu Pal Executive <br /> *Enter 'number of samples SCO,��, D the sampling procedure and ana ysis t e column constituents was as spec gR cer or Authorized Agent Date <br /> Taken during The day. MI fied in the Waste Discharge Order forty. <br /> Last First <br /> Form 02-9/74 . — <br />