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INSTkaCTIONS FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOA,
<br /> 1. Remove COPY 4 (dark yellow) and use for your worksheet. DISCHARGER SELF MONITORING REPORT '
<br /> : 2. Use ballpoint pen or typewriter for data entry forms. l
<br /> III 3. . Provide dates for beginning and ending in reporting
<br /> ing period blocks. uZa TRACY♦ CITY �,t
<br /> 4. Provide data as specified under column headings. UAL.IFORN1A ~ L:',TCNA,.L. WATER Q0ALX7Y LL
<br /> TRACY STP
<br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL RnAR1 t
<br /> 6. Appropriate signature is required at the bottom of the form.
<br /> 7. Remove COPY 3 and retain for your records. C; 4TRAL VALLEY REGION PO BOX 1029
<br /> 8. Send COPY $YiiK&QX,}RA X3Y.?63frvv'iPXc 2IsXd(r}�A,`X�pJC, S"v1(D'.7C:C.. . 12'D'1 S STRET zw TRACY LALIr
<br /> SACRA"`!ENT[tf CA 95816 ag 95376
<br /> YOUR REPORTING PERIOD IS Qt4T'1LY AND YOUR REPORTS MUST F`
<br /> BE SUBMITTED BY FMDAYS FOLLOWING THIS PERIOD. State NPDES Permit PA:r:
<br /> Year Mo. Day Year Mo. Day Code Number - Year Mo. Day
<br /> Transaction Facility R Yea r(Month for Reporting Date form was
<br /> �' 2 Code I.D. 5839 C'1.s801_ I this report �Q„31 j period: Beginning 74 '.d.3 .:L Ending T+a u3 pI �6 GGT9.3,54 computer printed
<br /> STATION DESCRIPTION s
<br /> CONSTITUENT NAME U <'
<br /> UNITS
<br /> SAMPLE TYPE
<br /> FREQUENCY y
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<br /> -7 �{ f N
<br /> Mu
<br /> .[teL J .x,2 7-75,77 7777
<br /> .ot. C7J� lZ
<br /> 17 V k,77777, M77 7
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<br /> --- Q ----r-
<br /> --- y
<br /> ,7 777 7T
<br /> 577 77=77
<br /> W
<br /> I ,7111,17
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<br /> --- L371
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<br /> T — :T"1Z'f f fTi rT."rr r .L.{
<br /> - W!fht+fY+.,*G'rMhw.'.`.-Yw.. +h`5«+ w� i'..�f�. ��'�"FTLS+.rw' ,+<'4r � .nrcM"x +hwH f .,f WW�f!t'ay.4ui+r. ,W w rtm+4. dS�=rK!+fd+�'t+`�n t. y�fF T•'.1 r' f.°L +`
<br /> ----- ,fy,U el
<br /> --- a� r,o8 /1r % �Z ��'77 17 / �
<br /> --- �� � ~ �
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<br /> --- '5 --- r 20 --- — ----
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<br /> I 1 13
<br /> Y4, r Sn$9Ei Nv' t
<br /> a,N
<br /> v.
<br /> + 1 MONTHLY AVERAGE 7t / e 17t
<br /> MONTHLY HIGH , ,9 Of O D
<br /> 30
<br /> MONTHLY LOW R"Ov 7
<br /> TOTAL RECORDINGS/MO
<br /> REQUIREMENT #1
<br /> Times Exceeded
<br /> REQUIREMENT #2 ,
<br /> qp
<br /> Times Exceeded s Mix ti^;y 1.
<br /> REQUIREMENT #3N; 3"-'-
<br /> 141
<br /> t .Times Exceeded <, <, `" q,4 ^” -
<br /> �Rnter number of samples Typped Name of Principal Executive Officer I declare under penalty of perjuryy that the foregoing is true and accurate, and thoT
<br /> taken. during the day. s3Ci3tt Darrell D the sampling procedure and onalysis used for the column constituents was as speci- L
<br /> Form Q&9]4 46
<br /> Last First MI Pied in The Waste Discharge GYder for this facility. Sigg Lure of Pr nc pal Executive Yr. Mn Day COPY
<br /> / Officer or Authorized Agent Date
<br /> 1.
<br />
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