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DNR General Permit <br />Report of Water Use <br />Temporary Basin Dewatering <br />Less than 50 million Gallons per Year <br />Contact Information <br />Contact Person: <br />Company Name: <br />Address: <br />Pumping: Report number of gallons withdrawn this calendar year by month <br />January July <br />February August <br />March September <br />April October <br />May November <br />June December <br /> Year Total <br />~~~4FT <br />Measurement Method: Please indicate the method used <br />^ 1. Flow Meter <br />^ 2. Flow Rate Meter with: ^ Totalizer ^ Hour Meter <br />^ 3. Timing <br />Device: ^ Electric meter ^ Hour Meter <br />^ 4. Approved Alternate Method: (describe) If not already approved, request approval <br />^ 5. Estimated: (describe) An approved measuring method is required <br />Fees: check one <br />Projects pumping less than 15 million gallons per year ^ none <br />Projects pumping 15 million to 50 million gallons per year ^ $50 <br />Return after the project is completed, but no later than February 15th of the year <br />after the appropriation occurs. A report is required for each calendar year of pumping activity. <br />Make checks payable to DNR -Waters, and mail to: If you have any questions concerning reporting, <br />DNR -Waters please call (651) 296-0435. <br />500 Lafayette Rd Box 32 You can also leave a message after hours. <br />St. Paul, MN 55155-4032 <br />Year- <br />General Permit 2000-6117 <br />Signature Date <br />