4040 Paramount Blvd.
Lakewood, CA 90712
CENTRAL BASIN WATERMASTER
ADMINISTRATIVE BODY
Request for Carryover Conversion
CONTACT INFORMATION
Central Basin Judgment – Party Name:
Contact Name:
Address:
City: State: Zip:
Phone: Email:
CARRYOVER CONVERSION REQUEST
QUANTITY OF CARRYOVER CONVERSION REQUESTED: ACRE-FEET
REQUEST ACCESS TO COMMUNITY STORAGE POOL IF REQUESTED CARRYOVER CONVERSION EXCEEDS INDIVIDUAL STORAGE ALLOCATION (CHECK YES OR NO)? YES NO ADMINISTRATIVE YEAR FOR CARRYOVER CONVERSION TO OCCUR (i.e. 2016/17):
(Administrative year is from July 1 to June 30)
Name of Authorized Representative (Print):
Signature of Authorized Representative:
Date:
***FOR WRD USE ONLY***
Date Received:_______________________________________________________________________ Received by:_________________________________________________________________________