State Water Resources Contro l Board Submit Form DIVISION OF WATER RIGHTS / fL 1

STATE WATE~l~~lATEMENT OF W~TER DIVERS~ON AND USE /tbfl!f:::/ · fX'C rnWTQnl Rn ~ P.n NOTE: A Statement IS not a Water Rtght u-1~ 'Re'AO 1'11~ ..tn' ACHr;D INFORMATION AND INSTRUCTION SHEET BEFORE COMPLETING THIS f ORM 7 . (; U

A. Claim a nt '1D.l ~P-'lll.. uiAIIh JU: 4 b !I

c laimant Nameg~V of1'b\I~PJaljWJ,S ff <?Tt.sf~ J L c_ I MailinQ Address SA,RAMtN ;_{t ( I

7 0 '7 LA ~~ V I L K /-ltv~ Citv~ "flat J'Z A u W\. v:l 04 . Zip q (_j q £' <-j

Phone Number

7 ol-:A i l - ~S'~ f \ I Email Address (if available) / €) C @

A r0C!>R~t..U(. oc..c.~ \ rV\ , Ao o o 11/\ Aqent Name (if applicable)

Mailino Address Citv State Zip

Phone Number I Email Address (if available) I

Land Owner Name (if different from claimant)

MailinQ Address Citv State Zip

B. T ype of Claim I Check the box(es) which describe the type of claim(s) under which you are diverting water

~ending Appropriabve Application 0 Riparian r ,..... ~ - 0 Court Decree .-7

If vou cheoked ves for Court Decree or PendinQ Appropriative Application. list the decree number or application ID:

I C. Water Course Description (required) ·r

s~~N;:~t6 ; int ~f~s~~tv\ Tributart L ?J A U YV\ ,q R t li ~ R

D. Legal Land Description (required)

Provide the location of the Point of Diversion using one of the following methods (check one box and enter c9,ordinates, 1f aw ble):

0 Latitude/Longitude Measurements: /22P )?'5? /D5"UJ 3go/O )2. b} ) 11

0 California Coordinate System (NAD 1983):

I ~ USGS Topographic Map with point of diversion labeled on map (if checked yes, please attach map)

Countv (reQuired)

?o1v o JNL ~ I Assessor's Parcel Number(s). if assiqned I

Provide Public Land Description to nearest 40 acres (if assigned) I Y. of the Y. of Section , Township , Range ~ , B&M I

E. Place of Use Description (required) I Prova e :(iQener~~escriptiG of the are~n w~h the water w.f used.

)~ D ~fl. _o (.< il 0 !ZoD u <'- ·I D)\.) Provide an outline of the Plaoe of Use using one or both of the following methods (check box indicating each map attached}

0 USGS Topographic map 0 County Assessor's paroel map ~1-\ o--\o F. Purpose of Use Description (required) I

Provide a listinQ of use types (s~nstructions for a listinQ of water uses)

::f ll 4? I Or #Q I fDIV ~ D n 2 G IJ c R f{ I

v uv~ YAf2 D Number of Acres (if applicable) I Persons Served (if applicable)

, Stock Watered (if applicable)

::;_C., CONTINUE TO PAGE 2

~0 1-0~ ~(b 13 5 022317 v::J ''broiL~

Additional copies of this form, instructions on how to complete this form and water right information can be obtained at http://www,waterboards.ca.gov/waterrightslwater issues/programs/diversiOn use/. This form version will expire on 12/31/2011 .

PAGE 2 of 2: INITIAL STATEMENT OF WATER DIVERSION AND USE CLAIMANT NAME I SOURCE/TRIBUTARY DIVERSION WORKS NAME I

I G. Diversion Works Description (required)

Name of Diversion Works, if named. I Year in which diversion commenced (or specify nearest known vear}

List anv related existinQ water riQhts. if applicable (for example. an appropriative ris:~ht usinQ the same diversion works}. I Type of Diversion Facility (select one) i ~Gravity O creek Pump D well Pump D Other (please specify):

I

Method of Measurement: O weir 0 Flume 0 In line Flow Meter I (check one box) 0 Electric Meter 0 Estimate D Other (please specify):

Capacity of Diversion Works (specify unit of measure) I Capacity of Storage Tank or Reservoir (if applicable)

m Acre-feet O cfs 0 gpm 0 gpd 0 Gallons

H. Quantity of Water Diverted (Required - if amounts are available, list below- otherwise check months in which d iversion occurred)

Provide the Quantity of water diverted each month in the table below as measured in (check one box) 0 Gallons ~Acre-feet

Year I Ja~ I F)( lx I Apr I Mav I Jun I Jul I AuQ 'Sep ' Oct I NK l oex ~~~ I. Recent Water Use

Provide the annual water use in recent years: Maximum ::;....o 0 Gallons ~Acre-feet

Minimum y 0 Gallons J0 Acre-feet

J . Maximum Rate of Diversion (if available)

If available, provide the maximum rate of diversion achieved in each month as measured in (check one box) Ocfs O gpm D aPd

Year I Jan I Feb I Mar I Apr I Mav Jun I Jul I AUQ I Sept I Oct ' Nov ' Dec

K . Miscellaneous Water Use (answer only sections applicable to your diversion) .,

Water Conservation: Are you curren0 employing any methods of water conservation? []YES NO I

If ves. describe anv water conservation efforts in current use. I Water Quality and Wastewater Reclamation: Are you now or have you been using recla1med water from a wastewater treatment facility, desalination facility or water polluted by waste to a degree that unreasonably affects such water for other beneficial uses?

D YES Rl.NO

Conjunctive use of surface water and groundwater: Are you using groundwater in lieu of surface water?

~YES 0 No I L. Certification of Statement (required) "' I declare under ~alty of pe~ury that the information in this statement of water diversion and use is true to the best of my knowledge and belief.

*DATE: L q/; ( at 2'<2/l...- 0 /Y1 A , Cahforma

~ (county)

I *SIGNATURE: ct /)_ 1- _ *PRINTED NAME: A ru o rc. ~ LA.J J, JZLoc~ H uv 1 I

(first name) (middle inijial) (last name)

I COMPANY NAME: ¥\ 0cc..l-\ 1rv \' 2 ~-/-d1t L L <:__ I

UPON COMPLETION OF THIS STATEMENT, ATTACH ALL SUPPORTING DOCUMENTATION AND MAPS AND MAIL TO:

State Water Resources Control Board Division of Water Rights PO Box 2000 5022317 Sacramento, CA 95812-2000

Additional copies of this form, instructions on how to complete this form and water right information can he obtained at http://www.waterboards.ca.gov/waterrights/water issues/programs/diversion use/. This form version will expire on 12/31/2011 .

l ~ ·?'

Marin

~ • «"'CC

WNER: ANDREW FLOCCHINI

SOURCE:

UNNAMED STREAM, SAN PABLO WATERSHED

LOCATION OF RESERVOIR:

WITHIN NW1/4 NE1/4 OF PROJECTED SECTION 27, T4N, R6W, MDB&M

COUNTY OF:

SONOMA

5022317

-( l ·'

u lA CALJF()AMA ENVIRONMENTAL PROTECTION .IIGENCY

STATE WATER RESOURCES CONTROL BOARD DIVISION OF WATER RIGHTS

RESERVOIR INVESTIGATION

RESERVOIR 10 NO. 543 ENFORCEMENT

Division of Water Rights Inspection (Fiocchini) 02/07/2011 Page 5 of5

Photograph No. 10 Weir structure on ..spillway.

. . Division of Water Rights Inspection (Fiocchini) 02/07/2011 Page 4 of5

Photograph No. 5 Groundwater well next to reservoir. Per the owners' statements, groundwater from this well is not ever put into the reservoir.

Photograph No. 8 Irrigation pumps that withdraws water from the reservoir to irrigate the vineyards. The owners said the irrigation pumps have 15 horsepower. Vineyard place of use in the background.

Pl~ c~ o ~ vS 6.

5022317

Division of Water Rights Inspection (Fiocchini) 02/07/2011 Page 3 of 5

Photograph No. 3 Reservoir.

Photograph No. 4 Adjacent pastl.Jre that is irrigated with well water.

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