29
eWRIMS RMS http://wb-sb-ewrims-rms-t/TestEnvironment/ReportList.aspx[1/24/2018 10:39:22 AM] TEST ENVIRONMENT This 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 a submitted 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 a Previous Year” found at the bottom of this screen. Invoice can be viewed by selecting “Invoice” in the action column. Submitted reports can be accessed for viewing and printing at any time by selecting “View” in the action column. Water Right ID Primary Owner Face Value (acre-ft/yr) County Source Type Year / Revision Status Date Submitted Action S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2017 / 1 In Progress Start View S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2016 / 1 Not Started Start S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2015 / 1 Not Started Start S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2014 / 1 Not Started Start S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2013 / 1 Not Started Start S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2012 / 1 In Progress Start View S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2011 / 1 Submitted 12/7/2012 View Amend S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2010 / 1 Submitted 12/7/2012 View Amend S009489 SANTA CLARA CO PARKS & REC DEPT 0.0 Santa Clara SANBORN CREEK Supplemental Statement of Water Diversion and Use 2009 / 1 Submitted 12/7/2012 View Amend Sample Only

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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

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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]

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

Sam

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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]

Sample

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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.

Sample

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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

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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

Email

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

Sample

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