WELL USER REGISTRATION FORM

General Information

 In order to properly adopt, implement and administer the Basin’s Groundwater Sustainability Plan (GSP), the Indian Wells Valley Groundwater Authority (Authority) has determined that it needs to obtain the following information from all owners and users of groundwater extraction wells within the Indian Wells Valley Groundwater Basin (Basin).  As a result, the Authority must require all owners and users of groundwater extraction wells to register with the Authority by no later than October 1, 2019.

Please fill this Form out very carefully and to the best of your ability and seek assistance from the Authority if needed.  Failure to properly and completely register could adversely affect your property as the information in this form will be used in the final development and implementation of the GSP.

For questions or assistance in completing this form, please contact: Don Zdeba, IWVGA Acting General Manager at 760-384-5555 or don.zdeba@iwvwd.com.

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Primary Contact Person *
Primary Contact Person
Are you the Owner or a User? *
Mailing Address *
Mailing Address
Property Using Groundwater Address: *
Property Using Groundwater Address:
Best Contact Number to Reach you: *
Best Contact Number to Reach you:
Current Type of Water Use Info: (mark all that apply)
If you selected Agriculture, please provide the following below: Acres in Production and Crop Type If you selected "Commercial/Industrial" or "Other/Combination", please specify below.
-De-minimis users are extractors who use LESS than 2 acre-feet per year for DOMESTIC PURPOSES ONLY. -Non-De-minimis users are extractors who use MORE than 2 acre-feet per year.
Please provide your annual production in ACRE FEET for the following years: 2010 2011 2012 2013 2014 2018
Provide your annual Production in ACRE FEET for each of the following years: 2010 2011 2012 2013 2014 2018
Provide your annual Production in ACRE FEET for each of the following years: 2010 2011 2012 2013 2014 2018
Please provide your County Permit Number and your Parcel Number below.
IF YOU CHECK YOU ARE A DE MINIMIS EXTRACTOR ABOVE, YOU ARE DONE. PLEASE SUBMIT FORM NOW
Well Physical Address:
Well Physical Address:
Year well installed: Well Depth: Static Water Level: Casing Diameter (inches) Ground elevation:
Does the well have a meter?
meter manufacturer: Model No.: Size (inches):