[SUMMARY OF FINAL SUBMITTED VERSION]


SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2020

Primary Owner: XARIA THAO
Statement Number: S026139
Date Submitted: 03/15/2021
1. Water is used under
Other: well
2. Year diversion commenced 1980
2. Purpose of Use
Domestic 4 persons
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 0.006138 0 0.006138
February 0.006138 0 0.006138
March 0.006138 0 0.006138
April 0.006138 0 0.006138
May 0.006138 0 0.006138
June 0.006138 0 0.006138
July 0.006138 0 0.006138
August 0.006138 0 0.006138
September    0.006138 0 0.006138
October 0.006138 0 0.006138
November 0.006138 0 0.006138
December 0.006138 0 0.006138
Total 0.073656 0 0.073656
Type of Diversion Direct Diversion Only
Comments
5. 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 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 (Gallons Per Day)
January 65
February 65
March 65
April 65
May 56
June 65
July 65
August 65
September 65
October 65
November 65
December 65
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 Xaria
Last Name Thao
Relation to Water Right Diverter of Record
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 Xaria
Last Name Thao
Relation to Water Right Diverter of Record
Information on Certification and Signatory
Name of Person Signing and Certifying the Report Xaria Thao
Date of Signature 03/15/2021