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FORMS:  Annual Groundwater Production Report

Please complete the online form below.  Or you may print and mail the form to our office.
Owner Full Name      
HGCD Well #      
HGCD Permit #      
System      
Phone             
Email      
For Year      
 
Water Use:   Municipal/Public
Household
Irrigation
Commercial
Other
     If other, describe:
     		 
       
Shrinkage %    
Number of Connections Served    
Estimate of Population Served     
   
Method of Measurement:    Meter     Other
If other, describe:
 		 
       
MONTH WATER METER
START		 WATER METER
STOP		 TOTAL GALLONS
PUMPED
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
 

Total for Year

 
       
Water Operator Full Name     
   
Water Operator Email     

Water Operator Electronic Signature  (type full name below)
  		  
       
Date  (mm/dd/year)  

 

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