[SUMMARY OF FINAL SUBMITTED VERSION]


REPORT OF LICENSEE FOR 2018

Primary Owner: OSTROM FAMILY TRUST
Primary Contact: WILLIAM L OSTROM

Date Submitted: 03/27/2019

Application Number: A011501
License Number: 003393

Source(s) of Water POD Parcel Number County
ANDERSON SPRING 008-120-009, Sierra

MAX Direct Diversion Rate: 0.125 CFS
MAX Collection to Storage: 0 AC-FT
Face Value: 38.2 AC-FT

Permitted Use(s) Acres Direct Diversion Season Storage Season
Domestic 0 05/01 to 10/01
1. Project Abandoned
The project has been abandoned and I request revocation of my water right license No
2. Compliance with License Terms and Conditions
I have currently reviewed my water right license and I am complying with all terms and conditions Yes
Description of noncompliance with terms and conditions
3. Changes to the Project
Intake location has been changed
Description of intake location changes
Type of use has changed
Description of type of use changes
Place of use has changed
Description of place of use changes
Other changes
Description of other changes
4. Purpose of Use
Domestic 324
Municipal 324
Special Use Categories
C1. Are you using any water diverted under this right for the cultivation of cannabis? No
5. Maximum Rate of Diversion
Month Rate of Diversion (Cubic Feet Per Second)
January 0
February 0
March 0
April 0
May 0.1250
June 0.1250
July 0.1250
August 0.1250
September 0.1250
October 0
November 0
December 0
6. Amount of Water Diverted and Used
Month Amount directly diverted
(Acre-Feet)
Amount diverted or
collected to storage
(Acre-Feet)
Amount used
(Acre-Feet)
January 0 0 0
February 0 0 0
March 0 0 0
April 0 0 0
May 0.78 0 0.78
June 0.95 0 0.95
July 1.5 0 1.5
August 0.92 0 0.92
September    1.3 0 1.3
October 0 0 0
November 0 0 0
December 0 0 0
Total 5.45 0 5.45
Type of Diversion Direct Diversion Only
Comments
Water Transfers
6d. Water transfered No
6e. Quantity transfered (Acre-Feet)
6f. Dates which transfer occurred / to /
6g. Transfer approved by
Water Supply Contracts
6h. Water supply contract No
6i. Contract with
6j. Other provider
6k. Contract number
6l. Source from which contract water was diverted
6m. Point of diversion same as identified water right
6n. Amount (Acre-Feet) authorized to divert under this contract
6o. Amount (Acre-Feet) authorized to be diverted in 2018
6p. Amount (Acre-Feet) projected for 2019
6q. Exchange or settlement of prior rights
6r. All monthly reported diversion claimed under the prior rights
6s. Amount (Acre-Feet) of reported diversion solely under contract
7. Water Diversion Measurement
a. Required to measure as of the date this report is submitted Yes
b. Is diversion measured? Yes
c. An alternative compliance plan was submitted to the division of water rights on
d. A request for additional time was submitted to the division of water rights on
Measurement ID numberM011534
This Device/Method was used to measure water during the current reporting periodYes
M1. Briefly describe the measurement device or methodELECTRONIC FLOW METER AT CL2, AND PROP METER ON OVERFLOW
M2. Nickname
M3. Type of device / methodFlow meter (electromagnetic)
M4. Device make
M5. Serial number
M6. Model number
M7. Approximate date of installation02/01/2012
M8. Additional info
M9. Approximate date the measuring device was last calibrated or the measurement method was updated05/12/2012
M10. Estimated accuracy of measurement99
M11. Description of calibration methodOFFSET AGAINST 5 GALLON PAIL
M12. Describe the maintenance schedule for the device/method10 YEARS
Information for the person who last calibrated the device or designed the measurement method
M13. NameCLIFF
M14. Phone number2099481882
M15. EmailRRLEWISH2O@GMAIL.COM
M16. Qualifications of the individualPerson trained and experienced in water measurement (for diversions of less than 100 acre-feet per year - no specific training is required; the person using any equipment and reporting the information must know how to use the equipment and submit correct information)
M17. License number and type for the qualified individual above and/or any other relevant explanationLARRY OSTROM 504513
M18. Type of data recorder device / methodDigital register (flow meter)
M19. Data recorder device makeCHEM FLOW
M20. Data recorder serial number
M21. Data recorder model number
M22. Data recorder units of measurementGallons
M23. Frequency of data recordingMore frequent than hourly
M24. Additional data recorder infoSYSTEM IS A RATIO CHLORINATION UNIT MEASURES GALLONS AND REPORTS TO A TOTALIZER FOR BOTH FLOW AND GALLONS. READ EVERY 3 DAYS AS REQUIRED BY HEALTH DIV
M25. I am required to report my diversion or storage data by telemetry as of the date this report is submittedNo
M26. I report my diversion or storage date by telemetry to the following website
Measurement Attachments
Measurement ID Number File Name Description Size
No attachments
Measurement Data Files
Measurement ID Number File Name Description Size
M011534 RR Lewis_Anderson Spring_2018 Diversion Data.xlsx RR Lewis Flow Meter Data (Anderson) - 2018 14 KB
8. Storage
Reservoir name Spilled this year Feet below spillway at maximum storage Completely emptied Feet below spillway at minimum storage Method used to measure water level
           
Conservation of Water
9. Are you now employing water conservation efforts? Yes
Description of water conservation efforts Outdoor water restrictions and other water supplier BMPs.
10. Amount of water conserved
11. I have data to support use reductions under this water right due to conservation efforts No
Water Quality and Wastewater Reclamation
12. During the period covered by this Report, did you use reclaimed water from a wastewater treatment facility, water from a desalination facility, or water polluted by waste to a degree which unreasonably affects the water for other beneficial uses? No
13. Amount of reclaimed, desalinated, or polluted water used
Conjuctive Use of Groundwater and Surface Water
14. During the period covered by this Report, were you using groundwater in lieu of available surface water authorized under your license? No
15. Amounts of groundwater used
Additional Remarks
A018782, A011120, A011501 are exercised by R.R. Lewis to provide domestic and municipal water supply to a common place of use. Each of these water rights is exercised from a shared point of diversion, which is equipped a single master water meter. The report shall not be deemed an election of rights. We reserve the right to amend this report in the future as new information becomes available. 
Attachments
File Name Description Size
No Attachments
Contact Information of the Person Submitting the Form
First Name LARRY
Last Name OSTROM
Relation to Water Right Primary Owner of Record
Information on Certification and Signatory
Name of Person Signing and Certifying the Report LARRY OSTROM
Date of Signature 03/27/2019