Annual Groundwater Production Report
Owner Full Name
First Name
Last Name
HGCD Well #
HGCD Permit #
System
Owner Phone
-
Area Code
Phone Number
Owner E-mail
For Year
Water Use
Municipal/Public
Household
Irrigation
Commercial
Other
If Other, please describe:
Shrinkage %
Explanation for Water Loss
Number of Connections Served
Estimate of Population Served
Submit Water Meter Readings for current year.
Water Meter Start
Water Meter Stop
Total Gallons Pumped
January
February
March
April
May
June
July
August
September
October
November
December
Total for Year
Water Operator
First Name
Last Name
Water Operator Email
Water Operator Electronic Signature (type full name)
Date
-
Month
-
Day
Year
Date Picker Icon
E-mail
Email
example@example.com
Submit
Submit
Should be Empty: