Curtailment Certification Form

If you are required to fill out a Curtailment Certification you may respond by using one of the methods below:

Questions regarding this form can be directed to: Phone: 916-341-5342
Email: SWRCB-Curtailment-Certification@waterboards.ca.gov

If you wish to look up curtailment information for a Water Right Application No, or to print proof of certification, enter the Number and County here:

Application No: *  A value is required. | Location of Water Right (County)*:    

*Required

Please complete One Water Right and Owner Information form for each Water Right:


Enter the Application or Statement number associated with a Water Right (e.g., A123456, G123456L001). If you are reporting for multiple Water Rights, please use a separate web submission for each Application or Statement number.
Application No: *  A value is required. | Location of Water Right (County):    
Primary
 Owner:* 		A value is required.
Address:* A value is required.
City:* A value is required. , State:  , Zip:
Telephone:* A value is required.
Email:
(Required*)

Curtailment Certification

 NO DIVERSION - I hearby certify that I will not be diverting any water under the above specified water right during the 2014 water diversion curtailment period.
ALTERNATE SOURCE I hearby certify that I will not be diverting any water under the above water right during the 2014 water diversion curtailment period. However, I will be serving all or a portion of its place of use with my alternate source(s) of water, as specified below:
Ground (well) water
Senior Post-1914 Appropriative Water Right | (Specify Permit/License No.):
Riparian water right(s) and/or pre1914 appropriative water right(s)*
Water use is reported under Statement of Water Diversion and Use No:
My use is excluded from filing a Statement of Water Diversion and Use under California Water Code section 5101 (generally, because the use included in other sufficient reports, or is from a spring that does not flow off your property).
None of the above.
Contract (purchased) water from:
Will serve the place of use by withdrawing water stored under Permit/License No:
Other source (specify):
SOLE SOURCE OF WATER FOR HEALTH AND SAFETY NEEDS
I hereby certify that the water right being curtailed is the only source of water available for human health and safety needs.
I also certify that I have looked into alternative water supplies from the following:



 Other:

HYDROELECTRIC POWER GENERATION/OTHER NONCONSUMPTIVE USE I hereby certify that I am directly diverting water for hydroelectric power generation or other nonconsumptive use and all water diverted is returned to the stream.
OTHER I have additional information explaining how much water I am diverting, the use of that water, the measures being undertaken to reduce use, and the basis on which I contend that the diversion and use is legally authorized notwithstanding the very limited amounts of water available during this drought emergency.

To submit this additional information, please send an email to SWRCB-Curtailment-Certification@waterboards.ca.gov with the additional information as an attachment to the email. Please also include the Application or Statement number, your Name and Phone number in the body of the email as well. Please call 916-341-5342 if you have any questions

*Please note that only limited natural or abandoned water is available during a curtailment period. Water released from upstream storage projects is not available to divert under a riparian or pre-1914 right.

By electronically submitting this form I declare that the information in this certification is true to the best of my knowledge.

Name
Phone No:

Revised 2014: April 16, May 28, June 6