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FORM 3.1.2 NOTICE OF TOTALIZING FLOW METER INSTALLATION

UPDATED 04/01/08

To be Filed by the Installer Within 20 Days of a Totalizing Flow Meter Installation, in Compliance with rule 3.1.2 of the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN WATER DIVISION NO. 3, THE RIO GRANDE BASIN. A certified meter test and Form 3.1 or 3.2 must be completed for this meter within 1 year of installation.
To: Division Engineer, Water Division No. 3 P.O. Box 269 301 Murphy Drive Alamosa, CO 81101 Telephone: FAX: (719) 589-6683 (719) 589-6685

CONTACT INFORMATION: OWNER Name: Address: City, State, Zip: Phone: E-Mail: USER (IF NOT SAME AS OWNER)

TOTALIZING FLOW METER INFORMATION: TOTALIZING METER MANUFACTURER: METER MODEL NUMBER: METER SIZE (IF APPLICABLE): METER SERIAL NUMBER: VOLUMETRIC UNITS (GALLONS, ACRE-FEET, ETC.): BEGINNING FLOW METER READING: DATE OF INSTALLATION: GPS COORDINATES OF METER: (FORMAT: UTM, DATUM: NAD 83)

WELL(S) MEASURED BY THIS METER (If more than one, attach copy of variance issued by Division Engineer):

Structure ID No.: Well Permit No: Case or Decree No.:
(if known)

Location

GPS Coordinates of Well(s) (if known):

¼¼, Section, Township, Range, PM (format: UTM, Datum: NAD 83)

SOURCE OF POWER TO PUMP(S): Electric.................... Windmill.................. Fossil Fuel (Gas, Propane, Diesel, etc.) ................. Other: Artesian............... Solar ...................

I hereby certify that the above information is true and accurate to the best of my knowledge. This totalizing flow meter was installed in compliance with the manufacturer's recommended specifications.

NAME OF METER INSTALLER:

_________________ SIGNATURE : ____

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DATE:

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