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INSTRUCTII FOR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTROL BOARD <br /> 1. Remove COPY 4 (dark yellow) and use for your worksheet. r <br /> 1. Use ballpoint pen or typewriter for data entry on farms. DISCHARGER SELF MONITORING REPORT III <br /> 3. Provide dates for beginning and ending in reporting period blocks. Y 1 '( <br /> 4. Provide data as specified under column headings. CALIFORNIA REGFONAL WATEP (SUi aZ _Y <br /> 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.).. CONTROL BOARD ,. <br /> b. Appropriate signature is required at the bottom of the form. j;.. "dTFtAL VALf1.I:.Y REGION <br /> 7. Remove COPY 3 and retain for your records .t <br /> 8. Send COPY%1P ACfl2e916�C druYFl Ms'o<.'dfiuMr.$CSP;4.tka?r"r >; - 3201 S STRt7ET z�", • x!.y CALIF <br /> --jACRAMENT01i CA 95P16 <br /> YOUR REPORTING PERIOD IS F °TiLy AND YOUR REPORTS MUST <br /> > State NPDES Permit <br /> BE SUBMITTED BY DAYS FOLLOWING THIS PERIOD. Year Mo. Day Year Mo Day Code Number Year Mo. Day <br /> Tra nsaction Facility Ye nth <br /> for Reporting 06 Date form was <br /> Q2 Code LD. i �? ' -L I this report .�Y �L I Period Beginning Ending j ° e computer printed •. <br /> STATION DESCRIPTION u., k+z <br /> CONSTITUENT NAME <br /> UNITS <br /> SAMPLE TYPE <br /> FREQUENCY <br /> MONTH DAY <br /> .; <br /> t/ ri + --- — —` -- - <br /> -- L ,.,n.c —.-rte _. w,. ._...._ qu• __ <br /> �1 _'[yam- - -� -- - — - <br /> -- -Z - - - - <br /> - — — — <br /> -- <br /> - --. - - - - - -- - ---- -- - <br /> f. <br /> i4_7 y <br /> L sI <br /> — -- <br /> -- LL _ -- --- — --- — -- - <br /> -- <br /> -- / _2 L _ If <br /> ZIZl 31F - - - - - - -- - --- <br /> .< , �- �, <br /> , <br /> fe <br /> 7 t <br /> -------- aw'; ----_—_ sy — --— i7k»5+,.. ------ —__---._-- R+ __ — -- ----- — ------- <br /> -- — i.,» �t{� — w» — w,rs77 <br /> / � �� — <br /> — v- _---� -- <br /> ----------- - <br /> ------------ <br /> _ _ <br /> --� <br /> Ym _......_....,_.--,_...._ i.. -------- _: .gy ....—,....._....�..�v —�..-._.--- +v-" — .,—...,_.� 2w.u.= <br /> 2' <br /> W -- 1 -------- r --------- q ------ n.., ----------- ----- *r' — — `"' ---------- ..y' -- -------- <br /> �� �, <br /> t MONTHLY AVERAGE L/,�"' ( =5 -� Z 1 , L "7 <br /> MONTHLY HIGH ai v31 7 '1 ' <br /> MONTHLY LOW / ( Z /ji.) ' r110 t <br /> TOTAL RECORDINGS/MO. —' / <br /> REQUIREMENT #1 <br /> Times Exceeded '+ <br /> REQUIREMENT #2s <br /> Times Exceeded I <br /> REQUIREMENT #3 <br /> A 1 <br /> LJ Times Exceeded L ,. <br /> T ed Name of Principal Executive Officer <br /> Enter number of samples YP P I declare under penalty of perjury that the foregoing is true and accurate, and that <br /> Taken during the day. SCO't't Darrell P, the sampling procedure and analysis used for the column constituents was as spec <br /> Last First MI fied in the Waste Discharge Order for this facility. S�ap4ficerre of Autho PiedE Agentre}1VP Yr. Mo. u^y COPY C4 <br /> Form Q2-9/]4Date <br />