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DBB-013 (10/02)

COLORADO GROUND WATER COMMISSION Room 818 Centennial Building, 1313 Sherman Street Denver, CO 80203 Administrative Reporting Three-Year Modified Banking

This form must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed.

Instructions:This form must be submitted prior to February 15th each year for the prior calendar year. Permit No. Location: Owner: 1 2 3 4 1/4 1/4 Sec ___ T R _ W ! Expanded Acres ! Change of Use ! Owner: Administrative Year ________________

Maximum Annual Permitted Appropriation - This is the value from your final permit. Average Annual Historic Withdrawal - This is average annual withdrawal that the well is restricted to under expanded acres or a change of use. Subtract line 2 from line 1 and enter here. Multiply line 3 by 3 and enter here. This is the maximum amount of banking possible.

5

Pumping Limit for this year - As approved in the order or line 11 of last years report.

6

Enter the amount from line 10 of last years report here, or enter the amount from line 2 if this is the first year under three year modified banking provisions, or enter the amount from line 15 of the Three-Year Modified Banking Worksheet if switching from the three-year rolling average. Enter total amount pumped this year. Subtract line 7 from line 6 and enter here.

7 8

9 10 11

Banking Reserve - Enter the lesser of lines 4 and 8 here. Add line 2 to line 9 and enter here. Pumping Limit for next year - Enter the lesser of lines 1 and 10 here.

ADMINISTRATIVE AGENT Signed and dated this ____________________________________________, 20_______. Signature Name
Please Print

___________________________________________________ __________________________________________________ ___________________________________________________ ___________________________________________________ ________________________________________________

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