SANTA ANA WATERSHED PROJECT AUTHORITY PERMITTEE NAME PERMIT#: COMPOSITE SAMPLE #: DATE GRAB SAMPLE # DATE FLOW FOR DAY SAMPLE WAS COLLECTED gallons SELF MONITORING REPORT FORM Monitoring Location 001 – Applicable Sample Applicable Compliance (C) (lbs/Day) Pollutant Results Limit (mg/L) Non-Compliance (NC) Monthly (mg/L) Avg. Max - pH (Field Result) High Value 6.0 - 12.0 - pH (Field Result) Low Value 6.0 - 12.0 Biochemical Oxygen Demand - 12,000 15,000 (BOD) - Total Suspended Solids (TSS) --- - - Arsenic 2.0 - - Cadmium 1.0 - - Chromium (Total) 2.0 - - Copper 3.0 - - Cyanide - Amenable 1.0 - - Cyanide - Total 5.0 - Dissolved Organic Carbon (DOC) 700 Fats, Oils, and Grease (FOG) 500 Hardness - - Lead 2.0 - - Mercury 0.03 - - Nickel 10.0 - Oil/Grease - Mineral/Petroleum 100.0 - - Pesticides 0.01 - - Polychlorinated Biphenyls (PCBs) 0.01 - - Silver 5.0 - - Sulfide Dissolved 0.5 - – - Sulfide - Total 5.0 - Total Dissolved Solids (TDS) -- - Total Toxic Organics (TTOs) 0.58 - Volatile Suspended Solids (VSS) --- - Zinc 10.0 - certify under penalty of law that this document and all attachments were prepared under my direction or supervision “I in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”
SANTA ANA WATERSHED PROJECT AUTHORITY PERMITTEE NAME PERMIT#: COMPOSITE SAMPLE #: DATE GRAB SAMPLE # DATE FLOW FOR DAY SAMPLE WAS COLLECTED gallons SELF MONITORING REPORT FORM – Monitoring Location 001 Pollutant Applicable Limit (mg/L) Applicable (lbs/Day) Sample Results (mg/L) Compliance (C) Non-Compliance (NC) Max Monthly Avg. pH (Field Result) High Value 6.0 - 12.0 - - pH (Field Result) Low Value 6.0 - 12.0 Biochemical Oxygen Demand (BOD) 12,000 15,000 - Total Suspended Solids (TSS) --- - - Arsenic 2.0 - - Cadmium 1.0 - - Chromium (Total) 2.0 - - Copper 3.0 - - Cyanide - Amenable 1.0 - - Cyanide - Total 5.0 - - Dissolved Organic Carbon (DOC) 700 Fats, Oils, and Grease (FOG) 500 Hardness - Lead 2.0 - - Mercury 0.03 - - Nickel 10.0 - - Oil/Grease - Mineral/Petroleum 100.0 - Pesticides 0.01 - - Polychlorinated Biphenyls (PCBs) 0.01 - - Silver 5.0 - - Sulfide – Dissolved 0.5 - - Sulfide - Total 5.0 - - Total Dissolved Solids (TDS) -- Total Toxic Organics (TTOs) 0.58 - - Volatile Suspended Solids (VSS) --- Zinc 10.0 - - “I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”
CIU-Permit-Template-SAWPA_FINALRev4-12182014.docx