[SUMMARY OF FINAL SUBMITTED VERSION]

SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2020

Primary Owner: LAKE CANYON MUTUAL WATER CO
Statement Number: S001160

1. Water is used under	Riparian Claim
2. Year diversion commenced	1956

2. Purpose of Use
Domestic	156

3. Special Use Categories
C1. Are you using any water diverted under this right for the cultivation of cannabis?	No

4. Amount of Water Diverted and Used
Month	Amount directly diverted (Acre-Feet)	Amount diverted or collected to storage (Acre-Feet)	Amount beneficially used (Acre-Feet)
January	0	0.593308	0.593308
February	0	0.968786	0.968786
March	0	0.590362	0.590362
April	0	0.819546	0.819546
May	0	0.762895	0.762895
June	0	0.807977	0.807977
July	0	0.69831	0.69831
August	0	0.636932	0.636932
September	0	0.540462	0.540462
October	0	0.371673	0.371673
November	0	0.252754	0.252754
December	0	0.396132	0.396132
Total	0	7.439137	7.439137
Type of Diversion	Diversion to Storage Only
Comments

5. Water Diversion Measurement
a. Required to measure as of the date this report is submitted	No
b. Is diversion measured?	My diversion is measured by a watermaster assigned to the following service area: Lake Canyon Mutual Water Company
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	M026105
This Device/Method was used to measure water during the current reporting period	Yes
M1. Briefly describe the measurement device or method
M2. Nickname
M3. Type of device / method	Flow meter (propeller)
M4. Device make
M5. Serial number
M6. Model number
M7. Approximate date of installation	06/15/1995
M8. Additional info
M9. Approximate date the measuring device was last calibrated or the measurement method was updated
M10. Estimated accuracy of measurement
M11. Description of calibration method
M12. Describe the maintenance schedule for the device/method
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
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
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
No data files

6. Maximum Rate of Diversion
Month	Rate of Diversion
January
February
March
April
May
June
July
August
September
October
November
December

7. Water Transfers
8a. Water transfered	No
8b. Quantity transfered (Acre-Feet)
8c. Dates which transfer occurred	/ to /
8d. Transfer approved by

Water Supply Contracts
8e. Water supply contract	No
8f. Contract with
8g. Other provider
8h. Contract number
8i. Source from which contract water was diverted
8j. Point of diversion same as identified water right
8k. Amount (Acre-Feet) authorized to divert under this contract
8l. Amount (Acre-Feet) authorized to be diverted in 2020
8m. Amount (Acre-Feet) projected for 2021
8n. Exchange or settlement of prior rights
8o. All monthly reported diversion claimed under the prior rights
8p. Amount (Acre-Feet) of reported diversion solely under contract

Credits Claimed
	Conservation	Reclaimed Water Use	Conjunctive Groundwater Use
Claimed? (Yes/No)	No	No	No
January
February
March
April
May
June
July
August
September
October
November
December

Conservation Supporting Information
Description of conservation methods
Description of baseline water use and time period
Description of conservation calculation methods
Conserved water used?

Additional Remarks

Attachments
File Name	Description	Size
No Attachments

Contact Information of the Person Submitting the Form
First Name	Wilfred
Last Name	Everts
Relation to Water Right	Company Representative
The information in the report is true to the best of his/her knowledge and belief	Yes

Contact Information of the Person Submitting the Form
First Name	Wilfred
Last Name	Everts
Relation to Water Right	Company Representative

Information on Certification and Signatory
Name of Person Signing and Certifying the Report	Wilfred Everts
Date of Signature	07/01/2021