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 %
Number of Connections Served
Estimate of Population Served
Method of Measurement
Meter
Other
If Other, please describe:
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
E-mail
Submit
Should be Empty: