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Withdrawal Record Form-2018 PDF
Withdrawal Record Form-2018 PDF
Permittee/Grantee :
Mailing Address :
Contact Person : E-Mail Address :
Tel. No/s. : Mobile No. : Fax No/s. :
Conditional Water Permit No. : __________________ Water Permit No. : ________________ Purpose: ________________
Name of Source : Amount of Water Granted (lps): Date Issued :
Location of Source :
NWRB Tag No. : Latitude : Longitude :
M E T E R R E A D I N G
(Every End of the Month)
MONTH INITIAL FINAL CONSUMPTION
(Cubic Meter) (Cubic Meter) (Cubic Meter)
Prepared by : Submitted by :
Position Position
NOTE:
1. INSTALLED PRODUCTION METER MUST BE TESTED BY NWRB OR ITS AUTHORIZED TESTING LABORATORY.
2. ANY REPLACEMENT OF METER MUST BE REPORTED TO NWRB WITHIN FIVE (5) DAYS INDICATING THE FOLLOWING:
PRODUCTION METER SERIAL NO. READING DATE REPLACED
OLD
NEW
3. ALL RECORD OF MONTHLY WATER WITHDRAWALS PER SOURCE MUST BE SUBMITTED EVERY THREE (3) MONTHS BY THE PERMITTEE
TO : THE CHIEF, MONITORING AND ENFORCEMENT DIVISION
NATIONAL WATER RESOURCES BOARD
This form may be reproduced by the Permittee. Keep this record on file. MED FORM 2014