Fillable Request for Carryover Conversion CONTACT INFORMATION (Water Replenishment District of Southern California)

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Request for Carryover Conversion CONTACT INFORMATION (Water Replenishment District of Southern California)

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The Request for Carryover Conversion CONTACT INFORMATION (Water Replenishment District of Southern California) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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4040 Paramount Blvd.
Lakewood, CA 90712
WEST COAST BASIN WATERMASTER
ADMINISTRATIVE BODY
Request for Carryover Conversion
CONTACT INFORMATION
West Coast Basin Judgment – Party Name:
Contact Name:
Address:
State:
Zip:
Phone:
Email:
CARRYOVER CONVERSION REQUEST
QUANTITY OF CARRYOVER CONVERSION REQUESTED:
ACRE-FEET
REQUEST ACCESS TO COMMUNITY STORAGE POOL IF REQUESTED CARRYOVER
CONVERSION EXCEEDS INDIVIDUAL STORAGE ALLOCATION (CHECK YES OR NO)?
YES NO
ADMINISTRATIVE YEAR FOR CARRYOVER CONVERSION TO OCCUR (i.e. 2016/17):
(Administrative year is from July 1 to June 30)
Name of Authorized Representative (Print):
Signature of Authorized Representative:
This request may be signed by the parties by facsimile, electronic or digital signature, and such signature shall be
deemed valid and binding on the party signing this request in that manner.
Date:
***FOR WRD USE ONLY***
Date Received:_______________________________________________________________________
Received by:_________________________________________________________________________
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Request for Carryover Conversion CONTACT INFORMATION (Water Replenishment District of Southern California)

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Completed 21 July 2020

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