Form LC-72B Fee for Diversions of CO River Water for Municipal, Indu

L
C-72B (x-xx)

Bureau of Reclamation

OMB Control No. 1006-0015

Expiration Date: xx/xx/2022

Contractor: Contract Number:

FEE FOR DIVERSIONS OF COLORADO RIVER WATER FOR MUNICIPAL, INDUSTRIAL, AND DOMESTIC USES IN THE STATE OF CALENDAR YEAR 20
Total monthly water diversion and return flow—please indicate unit of measurement:
 acre-feet  gallons  cubic-feet  cubic-meters  liters  Other (specify)
Diversions			Return Flows
Month	River Intakes (column a)	Wells (column b)	Metered Return Flow (column c)	Estimated Return Flow* (column d)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Annual Totals
Grand Totals	(columns a+b)		(columns c+d)
Computation of charges due pursuant to Article _____________ of this contract:
Total amount of water diverted
Per acer-foot charge for water ($.50/acer-foot above Hoover Dam, $.25/acer-foot below Hoover Dam)					$
Total charge (line 1 x line 2)					$
Contract administration charge					$
Total charge due and enclosed with this form (line 3 + line 4)					$

*If return flows are estimated; indicate the method used:
 As set forth in the contract	 Other methods (please enclose an explanation of methods used)
New diversion point(s) added during the calendar year ______________________________________________
Report certified correct and submitted by:
Name:___________________________________________ Date: ___________________________________________ Telephone:_______________________________________ Email:___________________________________________ Note: The completed report should be submitted by the date set forth in the water delivery contract to the Regional Director, Attention: LC-4200, Bureau of Reclamation, P.O. Box 61470, Boulder City, NV 89006

INSTRUCTIONS FOR COMPLETING FORM LC-72B

Paperwork Reduction Act Statement: This information is being collected to prepare and maintain complete, detailed, and accurate records of diversions of Colorado River water, return flow to the river, and consumptive use in compliance with the Consolidated Decree of the United States Supreme Court in Arizona v. California, entered March 27, 2006 (547 U.S. 150 (2006)). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the form displays a currently valid Office of Management and Budget (OMB) control number.

Estimated Burden Statement: Public reporting burden for this form is estimated to be 10 minutes which includes reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Bureau of Reclamation, Boulder Canyon Operations Office, Attention: LC-4200, P.O. Box 61470, Boulder City, NV 89006-1470.

Instructions: Please type or print legibly the following information.

1. In the top section of this form:

a. Name of the Contractor.

b. Contract number of contract for delivery of Colorado River water.

c. Name of the Lower Division State within which the Contractor’s entitlement is included (Arizona, California, or Nevada).

d. Calendar year for which the form is being completed.

2. In the middle section of this form:

a. Insert a checkmark to indicate the unit of measurement (see note below).

b. Column a—diversions from river intakes, if any, during each month and the annual total.

c. Column b – diversions from wells, if any, during each month and the annual total.

d. Column c – metered return flows, if any, during each month and the annual total.

e. Column d – estimated return flows, if any, during each month and the annual total.

f. The grand total of annual diversions (sum of columns a and b).

g. The grand total of annual return flows (sum of columns c and d).

3. In the bottom section of this form:

a. Line 1 – total amount of water diverted during the calendar year (see note below).

b. Line 2 – per acre-foot charge for water in accordance with the water delivery contract.

c. Line 3 – annual water diversion charge (Line 1 x Line 2).

d. Line 4 – annual contract administration charge in accordance with the water delivery contract.

e. Line 5 – sum of lines 3 and 4.

f. If return flows are estimated, insert a checkmark to indicate whether the method used is as set forth in the contract or by another method. If another method is used, please provide information about the method used.

g. List any new point(s) of diversion added during the calendar year.

h. The name and telephone number of the person submitting this report in case of questions.

i. The date the form is completed.

4. Return the completed Form LC-72B with a check payable to the Bureau of Reclamation in the amount shown on line 5 to the address shown at the bottom of the form.

Note: If a unit of measurement other than acre-feet is used, please convert the amount into acre-feet prior to calculating

the charge for diversions. For example, 1 acre-foot equals 325,851 gallons, 43,500 cubic feet, 1,233.5 cubic meters, or 1,233,466.5 liters.

Page 3 of 3