[SUMMARY OF FINAL SUBMITTED VERSION]

REPORT OF LICENSEE FOR 2015

Primary Owner: LARRY P LALAGUNA
Primary Contact: LARRY P LALAGUNA

Application Number: A013350
Permit Number: 008017

Source(s) of Water	POD Parcel Number	County
UNSP		Shasta
UNSP	042-260-008,042-	Shasta

MAX Direct Diversion Rate: 3700 GPD
MAX Collection to Storage: 0 AC-FT
Face Value: 2.4 AC-FT

Permitted Use(s)	Acres	Direct Diversion Season	Storage Season
Domestic	0	05/01 to 11/30
Irrigation	10	05/01 to 11/30
Stockwatering	0	05/01 to 11/30

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	12 FAMILY MEMBERS
Irrigation	10 Acres Pasture
Stockwatering	4 HORSES

5. 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	0.227098	0	0.205615
June	0	0	0
July	0	0	0
August	0	0	0
September	0	0	0
October	0	0	0
November	0	0	0
December	0	0	0
Total	0.227098	0	0.205615
Type of Diversion	Direct Diversion Only
Comments	Due to curtailment notice, water that was used was water for month of May. Storage tanks for domestic use were used sparingly.

Water Transfers
8e. Water transfered	No
8f. Quantity transfered (Acre-Feet)
8g. Dates which transfer occurred	/ to /
8h. Transfer approved by

Water Supply Contracts
8i. Water supply contract	No
8j. Contract with
8k. Other provider
8l. Contract number
8m. Source from which contract water was diverted
8n. Point of diversion same as identified water right
8o. Amount (Acre-Feet) authorized to divert under this contract
8p. Amount (Acre-Feet) authorized to be diverted in 2015
8q. Amount (Acre-Feet) projected for 2016
8r. Exchange or settlement of prior rights
8s. All monthly reported diversion claimed under the prior rights
8t. Amount (Acre-Feet) of reported diversion solely under contract

6. Maximum Rate of Diversion for each Month
Month	Maximum Rate of Diversion (GPD)
January	0
February	0
March	0
April	0
May	3700
June	3700
July	3700
August	3700
September	3700
October	3700
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

Conservation of Water
8. Are you now employing water conservation efforts?	Yes
Description of water conservation efforts	USING AS LITTLE AS POSSIBLE
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
THERE SHOULD BE A SIMPLE FORM FOR SMALL DOMESTIC USE LIKE THIS.

Attachments
File Name	Description	Size
No Attachments

Contact Information of the Person Submitting the Form
First Name	LARRY
Last Name	LALAGUNA
Relation to Water Right	Primary Owner of Record
Has read the form and agrees the information in the report is true to the best of his/her knowledge and belief	Yes