[SUMMARY OF FINAL SUBMITTED VERSION]


REPORT OF LICENSEE FOR 2010

Primary Owner: SHASTA FORESTS TIMBERLANDS, LLC
Primary Contact: W M BEATY & ASSOCIATES INC

Date Submitted: 08/18/2014

Application Number: A015559
Permit Number: 009735

Source(s) of Water POD Parcel Number County
ROCK CREEK 702-290-008 Shasta

MAX Direct Diversion Rate: 0 GPD
MAX Collection to Storage: 188 AC-FT
Face Value: 188 AC-FT

Permitted Use(s) Acres Direct Diversion Season Storage Season
Recreational 0 11/01 to 03/31
Domestic 0 11/01 to 03/31
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 one person - occasional guests / no landscaping
Recreational fishing
5. Amount of Water Diverted and Used
Month Amount directly diverted or
collected to storage
(Acre-Feet)
Amount used
(Acre-Feet)
January 15.666 15.666
February 15.666 15.666
March 15.666 15.666
April 15.666 15.666
May 15.666 15.666
June 15.666 15.666
July 15.666 15.666
August 15.666 15.666
September    15.666 15.666
October 15.666 15.666
November 15.666 15.666
December 15.666 15.666
Total 187.992 187.992
Comments
6. Maximum Rate of Diversion for each Month
Month Maximum Rate of Diversion
(GPD)
January 0
February 0
March 0
April 0
May 0
June 0
July 0
August 0
September    0
October 0
November 0
December 0
7. 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
Rock Creek  Yes No 0 occular
Conservation of Water
8. Are you now employing water conservation efforts? No
Description of water conservation efforts
9. Amount of water conserved
Water Quality and Wastewater Reclamation
10. 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
11. Amount of reclaimed, desalinated, or polluted water used
Conjuctive Use of Groundwater and Surface Water
12. During the period covered by this Report, were you using groundwater in lieu of available surface water authorized under your license? No
13. Amounts of groundwater used
Additional Remarks
This is an instream resevoir where water is constantly spilling over the spillway. 
Attachments
File Name Description Size
No Attachments
Contact Information of the Person Submitting the Form
First Name Ross
Last Name Brazil
Relation to Water Right Other: Agent
Has read the form and agrees the information in the report is true to the best of his/her knowledge and belief Yes