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CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD <br /> MONITORING REPORT COMPLIANCE CHECKLIST <br /> FOR <br /> WASTE DISCHARGE REQUIREMENTS <br /> FOR <br /> DISCHARGES REGULATED BY TITLE 27 AND/OR PART 258 <br /> Order No.: R5-2003-0080 Reporting Frequency: Semi-annual <br /> Discharger: Forward Inc. Monitoring Period: 4t Quarter 2004 <br /> Date Due: 31 January 2005 <br /> Facility: Forward Grdwater Treatment Facility <br /> Date Received: 28 January 2005 <br /> RWQCB Reviewer: Ross Atkinson Date Reviewed: 7 February 2005 <br /> RWQCB <br /> Reference Parameter Yes No N/A Reviewer Comment <br /> Standard 1. Transmittal Letter <br /> Provisions <br /> (1993,1997,2000) a. Is there a transmittal letter signed by x <br /> an authorized representative? <br /> b. Does it include the required x <br /> Certification Statement? <br /> c. Is there a discussion whether any x <br /> violations have occurred since the <br /> last monitoring report was submitted? <br /> x 1,1-DCA,benzene, VC& <br /> d. If any violations did occur, does it xylenes detected in effluent <br /> describe actions taken or planned for sample, check sample was ND <br /> correcting those violations? for all VOCs <br /> Standard 2. Compliance Evaluation Summary <br /> Provisions x <br /> (1993,1997,2000) a. Map/Photo: Is there a map or aerial <br /> photograph indicating the locations of <br /> all monitoring points? <br /> b. Standard Observations: Is there a x <br /> summary and certification of completion <br /> of all standard observations for the <br /> WNW, and for receiving waters? <br /> Sr. Initials SWIM Entry_ <br />