Licensee Report

Last Name :

Middle Name :

First Name :

Year :

Direct Diversion : Yes No

Direct Diversion Unit : Gallon Acre-Feet

Monthly Amount :

• January :
• February :
• March :
• April :
• May :
• June :
• July :
• August :
• September :
• October :
• November :
• December :

Storage : Yes No

Did reservoir spill ? Yes No

How many feet below the reservoir if no spill :

Did you empty the reservoir ? Yes No

How many feet below the spillway at the end of the season :

Contact Person :

Contact Address :

Contact Phone Number :

Contact Fax Number :

Contact E-Mail Address :