[SUMMARY OF FINAL SUBMITTED VERSION]

SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2015

Primary Owner: SHASTA FORESTS TIMBERLANDS, LLC
Statement Number: S001567

1. Water is used under	Pre-1914 Claim
2. Year diversion commenced	1900

3-4. Maximum Rate of Diversion for each Month and Amount of Water Diverted and Used
Month	Rate of diversion (GPD)	Amount directly diverted (Acre-Feet)	Amount diverted or collected to storage (Acre-Feet)	Amount beneficially used (Acre-Feet)
January	0	0	0	0
February	0	0	0	0
March	0	0	0	0
April	0	0	0	0
May	14400	1.32	0	1.32
June	14400	1.32	0	1.32
July	9500	0.87	0	0.87
August	9500	0.87	0	0.87
September	7200	0.66	0	0.66
October	7200	0.66	0	0.66
November	0	0	0	0
December	0	0	0	0
Total		5.7	0	5.7
Type of Diversion	Direct Diversion Only
Comments

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

5. Water Diversion Measurement
a.	Measurement	Direct measurement using a device listed in Section 1 is "not locally cost effective" for water directly diverted and/or diverted to storage
b.	Types of measuring devices used
c.	Additional technology used
	Description of additional technology used
d.	Who installed your measuring device(s)
e.	Make, model number, and last calibration date of your measuring device(s)
f.	Why direct measurement using a device listed in Section 1 is "not locally cost effective"	No power at diversion point Other
	Explanation of why use of devices and technologies listed in Section 1 are "not locally cost effective"	The diversion is located in a remote location where access is limited and the amount of water being used for irrigation is minimal making direct monitoring of this diversion not cost effective.
g.	Method(s) used as an alternative to direct measurement	Other
	Explanation of method(s) used as an alternative to direct measurement	The measurement is an estimate based on other known water diversions with similar flow rates.

6. Purpose of Use
Irrigation	145 Acres Pasture

7. Changes in Method of Diversion

8. Conservation of Water
a.	Are you now employing water conservation efforts?	No
	Describe any water conservation efforts you have initiated
b.	Amount of water conserved	Acre-Feet
	I have data to support the above surface water use reductions due to conservation efforts.

9. Water Quality and Wastewater Reclamation
a.	Are you now or have you been using reclaimed water from a wastewater treatment facility, desalination facility, or water polluted by waste to a degree which unreasonably affects such water for other beneficial causes?	No
b.	Amount of reduced diversion
	Type of substitute water supply
	Amount of substitute water supply used
	I have data to support the above surface water use reductions due to the use of a substitute water supply

10. Conjuctive Use of Surface Water and Groundwater
a.	Are you now using groundwater in lieu of surface water?	No
b.	Amount of groundwater used
	I have data to support the above surface water use reductions due to the use of groundwater.

11a. Additional Remarks

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
The information in the report is true to the best of his/her knowledge and belief	Yes