REPORT OF LICENSEE

Primary Owner: Jeff Bauer
Primary Contact:

Date Submitted: 01/15/2019

Application Number: A018202
License Number: 006732

Source(s) of Water	POD Parcel Number	County
UNXX		Shasta

MAX Direct Diversion Rate: 0 GPD
MAX Collection to Storage: 11 AC-FT
Face Value: 11 AC-FT

Permitted Use(s)	Acres	Direct Diversion Season	Storage Season
Stockwatering	0		11/01 to 04/01

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
Fish and Wildlife Preservation and Enhancement	11

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 (Gallons Per Day)
January	325851.43
February	0
March	0
April	0
May	0
June	0
July	0
August	0
September	0
October	0
November	977554.29
December	2280960

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	1	0
February	0	0	0
March	0	0	0
April	0	0	0
May	0	0	0
June	0	0	0
July	0	0	0
August	0	0	0
September	0	0	0
October	0	0	0
November	0	3	0
December	0	7	0
Total	0	11	0
Type of Diversion	Diversion to Storage Only
Comments	As it rains the water runoff collects in the pond and a culvert allows the water to spill through when it fills. I don’t believe our permit allows for use. That’s what I was told by a state water board, water rights staff person.

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 number	M012015
This Device/Method was used to measure water during the current reporting period	Yes
M1. Briefly describe the measurement device or method	Staff gauge, surveyed for accuracy, down embankment of pond
M2. Nickname
M3. Type of device / method	Staff gauge
M4. Device make
M5. Serial number
M6. Model number
M7. Approximate date of installation	11/25/2018
M8. Additional info
M9. Approximate date the measuring device was last calibrated or the measurement method was updated	11/25/2018
M10. Estimated accuracy of measurement	10%
M11. Description of calibration method
M12. Describe the maintenance schedule for the device/method	Monthly check health of pvc and feet markings.
Information for the person who last calibrated the device or designed the measurement method
M13. Name
M14. Phone number
M15. Email
M16. Qualifications of the individual
M17. License number and type for the qualified individual above and/or any other relevant explanation
M18. Type of data recorder device / method	Paper chart
M19. Data recorder device make
M20. Data recorder serial number
M21. Data recorder model number
M22. Data recorder units of measurement
M23. Frequency of data recording
M24. Additional data recorder info
M25. I am required to report my diversion or storage data by telemetry as of the date this report is submitted	No
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
M012015	conversion table.xlsx	Kyles conversion table	10 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
Bauer	Yes		Yes		staff gauge

Conservation of Water
9. Are you now employing water conservation efforts?	Yes
Description of water conservation efforts	We do not use the water.
10. Amount of water conserved
11. I have data to support use reductions under this water right due to conservation efforts

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?
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?
15. Amounts of groundwater used

Additional Remarks
The rate of diversion is based on how much each month stored in a addition to the month prior until it 11 acre feet is reached, then the water spills.

Attachments
File Name	Description	Size
No Attachments

Contact Information of the Person Submitting the Form
First Name	Heidi
Last Name	Bauer
Relation to Water Right	Other: Spouse of primary owner

Information on Certification and Signatory
Name of Person Signing and Certifying the Report	Heidi Bauer
Date of Signature	01/15/2019