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FORM 7.1

- N OTICE

OF

R EACTIVATION

To be Filed at least 10 days prior to use of the well in Compliance with RULE 7 of the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN THE RIO GRANDE BASIN to notify the DIVISION ENGINEER of intent to REACTIVATE a WELL/PUMP previously reported as INACTIVE. *** NOTICE *** NOTICE *** NOTICE *** NOTICE *** A valid MEASUREMENT METHOD MUST be on file with the DIVISION ENGINEER before a WELL/PUMP can be reactivated.
TO: DIVISION E NGINEER , 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: THIS NOTICE IS FOR: CHECK ONE OF THE FOLLOWING AND L IST M ETERS THAT WILL NOW BE A CTIVE ENTIRE WELL (ALL PUMPS/METERS) [LIST ALL METERS] ONLY PUMPS/METERS AS LISTED USER (IF NOT SAME AS OWNER)

WELL LOCATION AND INFORMATION:
Well Permit No.: Case or Decree No.: Structure ID No.:
(if known):

¼,

¼,

Section

,

Township Ft. from N S

,

Range Ft. from

, E

PM W

Distance of Well from Section Lines

MEASUREMENT INFORMATION (CHECK ONE THAT APPLIES):
..... Report of NEW MEASUREMENT METHOD submitted on attached FORM 3.1 or 3.2, OR ..... POWER CONSUMPTION COEFFICIENT previously submitted on FORM 3.2, OR ..... Notice of TOTALIZING FLOW METER previously submitted on FORM 3.1
FAILURE TO HAVE A PREVIOUSLY-APPROVED OR NEW MEASUREMENT METHOD WILL RESULT IN THIS FORM BEING
RETURNED

WELL OWNER/USER CERTIFICATION:
The above information is true and correct to the best of my knowledge. I understand that the use of this WELL/PUMP is subject to the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN THE RIO GRANDE BASIN and that no water may be diverted from this WELL/PUMP until it is in compliance with those RULES, except to determine a POWER CONSUMPTION COEFFICIENT or install and verify a TOTALIZING FLOW METER. I further understand that to divert water in violation of those RULES may be subject to a complaint in the WATER COURT, fines of up to $500 per day, court costs and attorney fees as provided in 37-92-503, CRS.

SIGNATURE:
CHECK ONE: WELL OWNER WELL USER

DATE:

DIV 3 FORM 7.1.DOC

UPDATED: 04/01/08