[SUMMARY OF FINAL SUBMITTED VERSION]

SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017

Primary Owner: FRANK E. CAWELTI
Statement Number: S022707

1. Water is used under	Riparian Claim
2. Year diversion commenced	1978

3. Purpose of Use
No Use

4. Changes in Method of Diversion
was unable to afix pump in creek

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

5-6. 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	0	0	0	0
June	0	0	0	0
July	0	0	0	0
August	0	0	0	0
September	0	0	0	0
October	0	0	0	0
November	0	0	0	0
December	0	0	0	0
Total		0	0	0
Type of Diversion	No Diversion
Comments	I am not physcial able to put pump in creek - therefore no water was diverted

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 2017
6p. Amount (Acre-Feet) projected for 2018
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	No
b. Is diversion measured?	No
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	M006857
This Device/Method was used to measure water during the current reporting period	No
M1. Briefly describe the measurement device or method
M2. Nickname
M3. Type of device / method	Other: none needed for this year
M4. Device make
M5. Serial number
M6. Model number
M7. Approximate date of installation
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
M27. I have attached additional information on the method I used to calculate the volume of water
M28. Describe any documents related to this measurement device or method that are attached to this water use report

Measurement ID number	M006860
This Device/Method was used to measure water during the current reporting period	No
M1. Briefly describe the measurement device or method
M2. Nickname
M3. Type of device / method	Other: no water was divereted
M4. Device make
M5. Serial number
M6. Model number
M7. Approximate date of installation
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
M27. I have attached additional information on the method I used to calculate the volume of water
M28. Describe any documents related to this measurement device or method that are attached to this water use report

Measurement ID number	M006861
This Device/Method was used to measure water during the current reporting period	No
M1. Briefly describe the measurement device or method
M2. Nickname
M3. Type of device / method	Other: none was used
M4. Device make
M5. Serial number
M6. Model number
M7. Approximate date of installation
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
M27. I have attached additional information on the method I used to calculate the volume of water
M28. Describe any documents related to this measurement device or method that are attached to this water use report

8. Conservation of Water
a.	Are you now employing water conservation efforts?	Yes
	Describe any water conservation efforts you have initiated	limit watering to a timer & no water was diverted to the year 2017
b.	Amount of water conserved
	I have data to support the above surface water use reductions due to conservation efforts.	No

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.

Additional Remarks
no water was diverted in the year 2017

Attachments
File Name	Description	Size
No Attachments

Contact Information of the Person Submitting the Form
First Name	Frank
Last Name	Cawelti
Relation to Water Right	Diverter of Record
The information in the report is true to the best of his/her knowledge and belief	Yes