Laserfiche WebLink
INSi.,JCTIONS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOA--, I <br /> 1. Remove POPYpe(oarypewrit and use for Yrnforms.worksheet. DISCHARGER SELF MONITORING REPORT �F <br /> 2. Use ballpoint en ort typewriter for data entryon forms. <br /> 3. Provide dates for beginning and ending in reporting period blocks. uz TKACY* CITY OF <br /> 4. Provide data as specified under column headings. t, t" T1' �� '" r....c,. A. `r,t qc.7. *( ,� TfLACY }`(3 <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc). <br /> b. Appropriate signature is required at the bottom of the form. <br /> 7. Remove COPY 3 and retain for your records. f r+?b f_ <br /> 8. Send COPY 'E fo+{6RP(, Rbfg}oN.9,'Cffn`(PMaYiQis�,o'fdfi " QIf!K R.�oI(X�')E, a ." ( i TR ACS" !�6,L IF <br /> :0 5376 l <br /> YOUR REPORTING PERIOD IS "^"4THL'! AND YOUR REPORTS MUST fa <br /> BE SUBMITTED BY DAYS FOLLOWING THIS PERIOD. State NPDES Permit PA <br /> Year Mo. Day Year Mo. Day Code Number Year Mo. Day <br /> Q2Transaction Faality t Year/Month for Re artin <br /> Code D f this re ort P g p r y Date form was _ <br /> P �� f� I Period Beginning 7/7 Ending �b computer printed T _ <br /> STATION DESCRIPTION <br /> CONSTITUENT NAME <br /> UNITS <br /> SAMPLE TYPE " <br /> FREQUENCY <br /> MONTH DAY <br /> —,T --- — — -- — — — — <br /> r <br /> 3 <br /> -- — — — -- ------------- <br /> ------------_— — -- --- _ --- ------------ <br /> ---- _— — T — - — — -- — — - <br /> -- _ _ _ <br /> } ----- -- � - _ c3 J3 _ — — — <br /> 9 - -- - -- - --- <br /> - <br /> -- = - - - - - <br /> -- _ _ <br /> -- --- - <br /> -- -- _ <br /> 1� <br /> -- - - - - - - - - - <br /> -- -- <br /> -- - - - - - - - - - _ - - - - -- ———- <br /> 4 ------------- <br /> 7 <br /> 11, 7—­�,­+�Ml- <br /> -- ——————————— ————— w. <br /> ' ' -s <br /> — _ _ <br /> T { <br /> — L �? — — --- --- -- J <br /> -- y p ------------ <br /> > ; <br /> -- = --- - ---- -- <br /> rt <br /> 17 <br /> --- <br /> -- — --- — ---- -- --- --- — --- <br /> _ ---- <br /> // � ) /y'� i�../)',1/�-/� 777'. ^��/''//yam. ) J yyytM. <br /> a f+i 3 ('S/-V _1V_ AS �.� 5 F N 3f�-�.L-i:✓ _ `3 +ff^-f1 fY <br /> MIF <br /> .yy c, / jam, $ ... <br /> " —_ ___ — _f _-- ____ <br /> —__—---- —------ .. ,... <br /> C <br /> + MONTHLY AVERAG .�,., <br /> MONTHLY HIGH 1 <br /> MONTHLY LOW f <br /> TOTAL RECORDINGS/MO. ' <br /> REQUIREMENT #1 <br /> Times Exceeded '� ¢ <br /> REQUIREMENT#2 <br /> Times Exceeded <br /> REQUIREMENT #3 r <br /> Times Exceeded <br /> T ed Name of Princi al ,. <br /> *Enter number of samples yp p Executive Officer I declare under penalty of perjury that the fore oing is true and accurate, and that <br /> taken during the day. gh 1 <br /> Scott the samppling procedure and analysis used for t e column constituents was as sped- 5. wre of Pr'nc' al Execmlve Vr mo. pa <br /> Form 629/]4.. fast First MI fled in }he Waste Discharge Order for this facility. �f4'cer or Avrho Pzed Agem pate y CO <br />