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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/ReportList.aspx[1/24/2018 10:39:22 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
Logged in as: S009489 Annual Reports Log Out
Filter: Show all reports
Select “Start” in the action column below to begin a new report or continue a report in progress. If you would like to make changes to asubmitted report, select “Amend”. If you do not see the report for the year you are trying to file, use the hyperlink “Add a Report for aPrevious Year” found at the bottom of this screen. Invoice can be viewed by selecting “Invoice” in the action column. Submitted reports canbe accessed for viewing and printing at any time by selecting “View” in the action column.
WaterRight ID Primary Owner Face Value
(acre-ft/yr) County Source Type Year /Revision Status Date
Submitted Action
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2017 / 1 In
ProgressStartView
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2016 / 1 Not
StartedStart
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2015 / 1 Not
StartedStart
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2014 / 1 Not
StartedStart
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2013 / 1 Not
StartedStart
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2012 / 1 In
ProgressStartView
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2011 / 1 Submitted 12/7/2012
ViewAmend
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2010 / 1 Submitted 12/7/2012
ViewAmend
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2009 / 1 Submitted 12/7/2012
ViewAmend
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/ReportList.aspx[1/24/2018 10:39:22 AM]
Add a Report for a Previous Year
Sample
Only
eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementSummary.aspx?FORM_ID=365474[1/24/2018 10:40:02 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Summary Information
Below is a summary of the information pertaining to this Statement.
DIVERTER OF RECORD ADDRESS PHONE EMAIL
SANTA CLARA CO PARKS & REC DEPT 298 GARDEN HILL DR, LOS GATOS, CA, 95030 408-867-6940
MAIL RECEIVER (IF DIFFERENT THAN DIVERTER OF RECORD) ADDRESS PHONE EMAIL
No Mail Receiver
NAME OF SOURCE OF WATER POD PARCEL NO. COUNTY LOCATION
SANBORN CREEK Santa Clara
NAME OF DIVERSION WORKS DIVERSION WITHIN
SW 1/4 of SE 1/4 Sec. 15, T. 8 S, R. 2 W, MDB&M
DEADLINE
This statement is due by July 1, 2018.
The Division of Water Rights would like to remind users of reporting deadlines via email. Please check the email listed above. If emailsabove are not current, provide email information to receive updates and reminders:
Owner email
Agent email
Is the diverter of record information shown above correct? Yes No Is the mail receiver information shown above correct? Yes No
If the diverter of record or mail receiver information shown above is wrong or missing, click here to correct. Otherwise, please use thecontinue button to begin completing the online Supplemental Statement of Water Diversion and Use.
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementSummary.aspx?FORM_ID=365474[1/24/2018 10:40:02 AM]
Please allow up to four weeks for diverter of record, address, or mail receiver changes to be reflected on the Summary Information shownabove.
PLEASE SELECT BOX IF APPLICABLE: "I have permanently ceased any diversion and use of water from the point of diversion identified in this statement of waterdiversion and use. I hereby agree to immediately file a new statement of water diversion and use if I resume diverting or usingwater from this point of diversion."
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementPart1.aspx?FORM_ID=365474[1/24/2018 10:41:16 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Please answer all the questions. When finished, click "Continue" to go to the next page.
Part 1 of 9: CLAIM TYPE AND YEAR
PLEASE READ GENERAL INFORMATION
1. WATER IS DIVERTED AND USED UNDER (select all that apply) What's This?
Riparian claim
Pre-1914 claim
Pueblo
Court Decree No.:
Pending Appropriative Right
Other (explain):
2. YEAR DIVERSION COMMENCED
Water Code section 5103, subdivision (h) requires each person who files an initial statement of diversion and use to report the year inwhich the diversion was commenced as near as is known. If this field is blank, please provide the year.
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementUse.aspx?FORM_ID=380020[1/25/2018 7:08:12 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 2 of 9: USE OF WATER
3. Check the appropriate boxes and explain how the water was used:
Water was not used under this statement in 2017
Irrigation (Specify if Multiple Crops grown and provide the number of acres irrigated)
Multiple CropsWhat's This? Area Irrigated (acres) Primary Irrigation Method
Alfalfa YesNo
acres
Almonds and OtherNuts
YesNo
acres
Cannabis YesNo
acres Surface (example: flood)
Corn YesNo
acres
Cotton YesNo
acres
Fruit YesNo
acres
Golf Course YesNo
acres
Grains (wheat, oat) YesNo
acres
Yes
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementUse.aspx?FORM_ID=380020[1/25/2018 7:08:12 AM]
GrapesNo
acres
Hops YesNo
acres
Landscape YesNo
acres
Legumes (peas,beans, peanuts)
YesNo
acres
Pasture YesNo
acres
Plant Nursery(flowers, etc.)
YesNo
acres
Rice YesNo
acres
Safflower YesNo
acres
Sod (lawn grass) YesNo
acres
Sugar Beet YesNo
acres
Sunflower YesNo
acres
Tomatoes YesNo
acres
Tree Fruit (citrus) YesNo
acres
Tree Fruit (other) YesNo
acres
Tree Nursery(Christmas trees,etc.)
YesNo
acres
Vegetables YesNo
acres
Other YesNo
Total Acres Irrigated acres
Frost Protection (Specify number of acres) acres
Heat Protection (Specify number of acres) acres
Industrial (Specify)
Stockwatering (Specify number and type of animals)
Municipal (Specify population served)
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementUse.aspx?FORM_ID=380020[1/25/2018 7:08:12 AM]
Domestic (Specify number of persons, lawn/garden area, etc.)
Power Generation (Specify installed capacity in kW, MW, or hp)
Recreational (Specify boating, fishing, water contact sport, etc.)
Mining (Specify type)
Milling (Specify type)
Fire Protection (Specify name(s) of reservoir(s))
Dust Control (Where)
Fish Culture (Specify)
Incidental Power (Specify installed capacity in kW, MW, or hp)
Snow Making (Specify number of acres) acres
Fish and Wildlife Protection and/or Enhancement (Specify)
Other (Specify type of use)
4. CHANGES IN METHOD OF DIVERSION
Describe any changes in your project since your previous statement was filed. (New pump, enlarged diversion dam, location ofdiversion, etc.)
(Note: Input is limited to 4000 characters.)
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementSpecialUse.aspx?FORM_ID=365474[1/24/2018 11:12:11 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 3 of 9: SPECIAL USE CATEGORIES
This part of the form is intended for the reporting of information regarding special use categories, related to certain beneficial usesreported in Part 2 of the form, that have additional reporting requirements.
Cannabis Cultivation
C1. Are you using any water diverted under this right for the cultivation of cannabis?
Yes No
The total water use and total extent of any irrigated areas for all beneficial uses associatedwith this water right should be reported in Part 2 of this form. Click to confirm that all wateruse and beneficial uses associated with this water right are reported Part 2 of this form beforeproceeding.
C2. Provide the total amount of water used under this water right for cannabis cultivation duringthe 12-month reporting period:
acre-feet
If you have an amount in gallons, use this tool to convert gallons to acre-feet:
Gallons Convert to Acre-Feet
30500 Gallons = 0.093601 Acre-Feet
C3. Provide the total irrigated acreage (in square feet) of cannabis cultivated under this water rightduring the 12-month reporting period:
square feet
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementSpecialUse.aspx?FORM_ID=365474[1/24/2018 11:12:11 AM]
C4. Provide the amount of cannabis cultivated under this water right during the 12-monthreporting period by lighting condition type.
OutdoorCultivated Canopy Size square feetTotal Number of Plants Harvested during 12-month reporting period:
Number of Harvests
IndoorCultivated Canopy Size square feetTotal Number of Plants Harvested during 12-month reporting period:
Number of Harvests
Mixed LightCultivated Canopy Size square feetTotal Number of Plants Harvested during 12-month reporting period:
Number of Harvests
C5. Select all of the irrigation methods that are used to cultivate cannabis under this water right:
Hand waterDrip/micro spray irrigationFlood irrigationRow irrigationOther
C6. Is your cultivation of cannabis a commercial cannabis activity?
If you intend to apply for a license under California Department of Food and Agriculture'sMedical Cannabis Cultivation Program, your response will help the State Water Board toefficiently coordinate with the California Department of Food and Agriculture to verify yourwater source as required under Business and Professions Code section 19332.2.
Yes No
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMaximumRate.aspx?FORM_ID=365474[1/24/2018 11:25:01 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 4 of 9: MAXIMUM RATE OF DIVERSION FOR EACH MONTH (IF AVAILABLE)
If the rate of diversion data is not available, you may skip this portion of the report by clicking the "Continue" button below.
5a. The rate of diversion of water for each month entered in the table below is shown in units of:
Gallons per minute (gpm) What's This?
5b. Enter numerals only. For months where no water was diverted, enter 0 (zero). What's This?
January
February
March
April
May
June
July
August
September
October
November
December
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMaximumRate.aspx?FORM_ID=365474[1/24/2018 11:25:01 AM]
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementAmountUsed.aspx?FORM_ID=365474[1/24/2018 11:29:46 AM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 5 of 9: AMOUNT OF WATER DIVERTED AND USED
6. Note: Please report only the amounts diverted and used under this supplemental statement only. Do not report water divertedunder other water rights, groundwater, or water supplied or purchased from others.
If you have an amount in gallons, use this tool to convert gallons to acre-feet:
Gallons Convert to Acre-Feet
3000000 Gallons = 9.206662 Acre-Feet
6a. Type of diversion
Water was only diverted from a stream and used immediately (Direct Diversion Only)
Water was only diverted/collected from a stream to a storage reservoir to be used later (Diversion to Storage Only)
Water was both directly diverted and diverted to storage
No water was diverted
6b. Instructions for below: Water that is directly diverted (e.g. directly pumped from stream and applied to land) should only bereported in Column I (Amount Directly Diverted). Water that is diverted/collected to on-stream or off-stream storage/reservoirshould only be reported in Column II (Amount diverted or collected to storage). Column III should reflect the total amount of waterused (The amount used can include both directly diverted water and water diverted or collected to storage). It should be noted thatdepending on how water was diverted (Directly diverted or collected/diverted to storage) the appropriate column should be filledout, NOT both. If water was both directly diverted and collected/diverted to storage then the amounts need to be separated andapplied to the appropriate column and box.
Enter numerals only (no commas or letters)
I. Amount directlydiverted(If none, enter 0)
II. Amount diverted orcollected to storage(If none, enter 0)
III. Amount used (If none, enter 0) What's This?
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementAmountUsed.aspx?FORM_ID=365474[1/24/2018 11:29:46 AM]
January Acre-Feet Acre-Feet Acre-Feet
February Acre-Feet Acre-Feet Acre-Feet
March Acre-Feet Acre-Feet Acre-Feet
April Acre-Feet Acre-Feet Acre-Feet
May Acre-Feet Acre-Feet Acre-Feet
June Acre-Feet Acre-Feet Acre-Feet
July Acre-Feet Acre-Feet Acre-Feet
August Acre-Feet Acre-Feet Acre-Feet
September Acre-Feet Acre-Feet Acre-Feet
October Acre-Feet Acre-Feet Acre-Feet
November Acre-Feet Acre-Feet Acre-Feet
December Acre-Feet Acre-Feet Acre-Feet
Total Acre-Feet Acre-Feet Acre-Feet
6c. If the total water diverted or used above is 0, please provide an explanation. Permitted rights may be revoked for non-use.
(Note: Input is limited to 4000 characters.)
WATER TRANSFERS FOR THIS REPORT YEAR
6d. Was any water under this right transferred? Yes No
6e. If yes, please state quantity transferred in acre-feet: AF
6f. Dates which transfer occurred
From Month Day
To Month Day
6g. This transfer was approved by: State Water BoardDWRUSBR
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementAmountUsed.aspx?FORM_ID=365474[1/24/2018 11:29:46 AM]
Other
WATER SUPPLY CONTRACTS FOR THIS REPORT YEAR
6h. Did you have a water supply contract? Yes No
6i. Who did you have a water supply contract with? USBRDWROther
6j. Name of other provider:
6k. Contract Number:
6l. Source from which contract water was diverted:
6m. Is the point of diversion the same as the identified water right? Yes No
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. Is this contract an exchange or settlement of prior rights? Yes No
6r. If Yes, do you claim all monthly reported diversion under the prior rights? Yes No
6s. If No, what amount of reported diversion is solely under contract?
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMeasurement.aspx?FORM_ID=365474[1/24/2018 12:04:29 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 6 of 9: WATER DIVERSION MEASUREMENT
7a.I am required to measure as of the date this report is submitted
I am not required to measure as of the date this report is submittedInformation on measurement requirements
SUMMARY OF MEASURING DEVICES / MEASUREMENT METHODS ASSOCIATED WITH THE DIVERSION OR STORAGE OFWATER
7b. I measure my diversion and/or storage of water
My diversion is measured by a watermaster assigned to the following service area:
I do not measure my diversion and/or storage of water
7c. An alternative compliance plan was submitted to the Division ofWater Rights on:
(mm/dd/yyyy, example: 02/07/2009)
7d. A request for additional time was submitted to the Division ofWater Rights on:
(mm/dd/yyyy, example: 02/07/2009)
Select Measuring DeviceID Nickname This Device/Method was used to measure water during the current reporting
period
M006154 S009489 FlowMeter Yes No
Add new or remove measurement device(s) to your report by selecting the appropriate action below. The first option allows you to enterone device at a time. If you have multiple devices for this water right, you can return to this page and add additional devices. The secondoption allows you to import a device that you have previously entered if you use the same device for multiple water rights. The last option
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMeasurement.aspx?FORM_ID=365474[1/24/2018 12:04:29 PM]
allows you to remove any added devices from your report.
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMeasurementReport.aspx?FORM_ID=365474[1/24/2018 12:11:22 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
MEASURING DEVICE / MEASUREMENT METHOD INFORMATION
Attachments: additional documentation related to the measurement device or method should be attached to the water use report. Youwill be able to add attachments before submitting the completed report.
Measurement ID number:
M1. Briefly describe the measurement deviceor method:
M2. Nickname of measurement device/method(example: pump 1):
M3. Type of device / method: Measurement methodBubblerDoppler or other electronic deviceElectrical records dedicated to pumpFloatFlow meter (electromagnetic)Flow meter (positive displacement)Flow meter (propeller)Flow meter (ultrasonic)Flow meter (vortex)FlumePressure transducerStaff gaugeWeirOther
M4. Device make:
M5. Serial number:
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http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMeasurementReport.aspx?FORM_ID=365474[1/24/2018 12:11:22 PM]
M6. Model number:
M7. Approximate date of installation: (mm/dd/yyyy, example: 02/07/2009)
M8. Additional info:
MEASURING DEVICE / MEASUREMENT METHOD ACCURACY
M9. Approximate date the measuring devicewas last calibrated or the measurementmethod was updated:
(mm/dd/yyyy, example: 02/07/2009)
M10. Estimated accuracy of measurement: (enter as a percentage, example: 12%)
M11. Description of calibration method:
M12. Describe the maintenance schedule forthe device/method:
PROVIDE THE FOLLOWING INFORMATION FOR THE PERSON WHO LAST CALIBRATED THE DEVICE OR DESIGNED THEMEASUREMENT METHOD:
M13. Name:
M14. Phonenumber:
M15. Email:
M16. Qualificationsof theindividual:
California Licensed Professional Engineer (PE)
Person working under the supervision of a California Professional Engineer
California-licensed contractor authorized by the State License Board for C-57 well drilling or C-61Limited Specialty/D-21 Machinery and Pumps
Hydrologist or Engineer employed by a Federal Agency
Person trained and experienced in water measurement (for diversions of less than 100 acre-feet peryear - no specific training is required; the person using any equipment and reporting the information mustknow how to use the equipment and submit correct information)
M17. Provide license number and type for the qualified individual above and/or any other relevant explanation:
DATA RECORDER INFORMATION
M18. Type of device / method: Analog register (flow meter)Data logger (digital)Digital register (flow meter)Ledger
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementMeasurementReport.aspx?FORM_ID=365474[1/24/2018 12:11:22 PM]
Paper chartOther
M19. Device make:
M20. Serial number:
M21. Model number:
M22. Units of measurement: Gallons
M23. Frequency of data recording: Daily
M24. Additional info:
TELEMETRY INFORMATION
M25.I am not required to report my diversion or storage data by telemetry as of the date this report is submitted
I am required to report my diversion or storage data by telemetry as of the date this report is submittedInformation on Telemetry Requirements
M26. I report my diversion or storage date by telemetry to the following website:
CALCULATING VOLUME FROM RECORDED DATA
If your measuring device measures a flow rate, water velocity, or water elevation, attach a rating table or description of the method usedto convert the measured value into a volume of water.
M27. I have attached additional information on the method I used to calculate the volume of water.
ATTACHED DOCUMENTS
M28. Describe any documents related to thismeasurement device or method that areattached to this water use report:
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementCredit.aspx?FORM_ID=365474[1/24/2018 12:15:28 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 7 of 9: CREDITS
Please answer only those questions below which are applicable to your project.
8. CONSERVATION OF WATER
a. Are you now employing water conservation efforts?
Yes No
If YES, please describe any water conservation efforts you have initiated. (Note: Input is limited to 4000 characters.)
b. If you are claiming credit for water conservation under section 1011 of the Water Code, please show the amount of waterconserved in acre-feet:
Acre-Feet
I have data to support the above surface water use reductions due to conservation efforts.
Yes 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 bywaste to a degree which unreasonably affects such water for other beneficial causes?
Yes No
b. If you are claiming credit due to the substitution of reclaimed water, desalinated water or polluted water under section 1010 of the
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementCredit.aspx?FORM_ID=365474[1/24/2018 12:15:28 PM]
Water Code, please show amounts of reduced diversions and amounts of substitute water supply used:
Amount of reduced diversion:
State the 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.
Yes No
10. CONJUNCTIVE USE OF SURFACE WATER AND GROUNDWATER
a. Are you now using groundwater in lieu of surface water?
Yes No
b. If you are claiming credit due to the substitution of groundwater under section 1011.5 of the Water Code, please show the amountsof groundwater used:
I have data to support the above surface water use reductions due to the use of groundwater.
Yes No
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementRemark.aspx?FORM_ID=365474[1/24/2018 12:18:42 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 8 of 9: ADDITIONAL REMARKS AND ATTACHMENTS
Please add additional remarks:
(Note: Input is limited to 4000 characters.)
Attach a File
Maximum file size: 75 MB Preferred file formats: Microsoft Office Excel, Microsoft Office Word, JPEG, PDF or CSV
File Name no file selected
Description
Attached Files
Select File Name Description Size
No Attachments
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementRemark.aspx?FORM_ID=365474[1/24/2018 12:18:42 PM]
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementEnd.aspx?FORM_ID=365474[1/24/2018 12:20:06 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
Part 9 of 9: Please provide the contact information of the person completing this form:
Fields marked with * are required.
Relation to the water right*
Diverter of Record ( SANTA CLARA CO PARKS & REC DEPT )New Diverter of Record
Other Specify:
First Name*
Last Name*
Address*
Phone Number
If this Supplemental Statement includes water use for irrigation of cannabis, a filing fee of $200.00 will be charged (Water Code §1525(b) (10)). You will be provided with an invoice page that includes instructions and address information for filing your fee at the end of thisreport.
I declare that the information in this report is true to the best of my knowledge and belief*
You will be able to print a copy of this report after you click the Submit button or the Save Without Submitting button.
If you chose "Save Without Submitting" your report will not be filed.
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementEnd.aspx?FORM_ID=365474[1/24/2018 12:20:06 PM]
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/StatementCannabisInvoice.aspx?FORM_ID=365474[1/24/2018 12:22:09 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
SUPPLEMENTAL STATEMENT OF WATER DIVERSION AND USE FOR 2017
Water Right IDS009489
Diverter of RecordSANTA CLARA CO
PARKS & REC DEPT
INVOICE
Your Statement of Water Diversion and Use (S009489) has been successfully submitted.
Please mail a check or money order for the $200 cannabis water use fee with a printout of this invoice to the following address:
State Water Resources Control BoardDivision of Water RightsStatement of Water Diversion and Use ProgramPO Box 2000Sacramento, CA 95812-2000
Check or money order should indicate your statement number(s) (S009489) and be made payable to: State Water Resources ControlBoard. Do not send cash. A Statement reporting cannabis use is not considered submitted until the required fee has been received bythe Board. Cannabis water use filing fees are based on Water Code §1525 (b) (10).
DEADLINE: Payment must be postmarked by July 1st, 2018 in order to be recorded.
THIS SPACE FOR OFFICE USE ONLY R.___________________ AMT:___________________
After printing this invoice screen, please click the 'Return to List of Reports' button below to view reports for this Statement Number. Thelisting will give you the option of printing the submitted report for your records.
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/ReportList.aspx[1/24/2018 12:22:41 PM]
TEST ENVIRONMENTThis is a test site of the Electronic Water Rights Management System Report Management System (eWRIMS RMS). Data entered
into this site will be DELETED. Please go to the eWRIMS RMS production site in order to enter legitimate data.
Logged in as: S009489 Annual Reports Log Out
Filter: Show all reports
Select “Start” in the action column below to begin a new report or continue a report in progress. If you would like to make changes to asubmitted report, select “Amend”. If you do not see the report for the year you are trying to file, use the hyperlink “Add a Report for aPrevious Year” found at the bottom of this screen. Invoice can be viewed by selecting “Invoice” in the action column. Submitted reports canbe accessed for viewing and printing at any time by selecting “View” in the action column.
WaterRight ID Primary Owner Face Value
(acre-ft/yr) County Source Type Year /Revision Status Date
Submitted Action
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2017 / 1 Submitted 1/24/2018
ViewInvoiceAmend
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2016 / 1 Not
Started Start
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2015 / 1 Not
Started Start
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2014 / 1 Not
Started Start
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2013 / 1 Not
Started Start
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2012 / 1 In
Progress StartView
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2011 / 1 Submitted 12/7/2012
ViewAmend
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2010 / 1 Submitted 12/7/2012
ViewAmend
S009489SANTA CLARA CO
PARKS & RECDEPT
0.0 SantaClara
SANBORNCREEK
Supplemental Statementof Water Diversion and
Use2009 / 1 Submitted 12/7/2012
ViewAmend
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eWRIMS RMS
http://wb-sb-ewrims-rms-t/TestEnvironment/ReportList.aspx[1/24/2018 12:22:41 PM]
Add a Report for a Previous Year
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