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Method of Withdrawal: <br />(describe number of <br />wells, type and depth) <br />Discharges To: <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Pumping: Report number of gallons withdrawn this calendar year by month 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 />^ 4. Approved Alternate Method: (describe) If not already approved, request approval <br />^ 5. Estimated: (describe) An approved measuring method is required <br />i=ees: 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) 295-0435. <br />500 Lafayette Rd Sox 32 You can also leave a message after hours. <br />St. Paul, MN 55155-4032 <br />Signature Date <br />