Each report shall be prepared on a form provided by the board. The report shall include all of the following information: (

a) The name and address of the person who extracted groundwater and of the person filing the report. (

b) The name of the basin from which groundwater was extracted. (

c) The place of groundwater extraction. The location of the groundwater extraction facilities shall be depicted on a specific United States Geological Survey topographic map or shall be identified using the California Coordinate System or a latitude and longitude measurement. If assigned, the public land description to the nearest 40-acre subdivision and the assessor’s parcel number shall be provided. (

d) The capacity of the groundwater extraction facilities. (

e) Monthly records of groundwater extractions. The measurements of the extractions shall be made by a methodology, water-measuring device, or combination thereof satisfactory to the board. (

f) The purpose of use. (

g) A general description of the area in which the water was used. The location of the place of use shall be depicted on a specific United States Geological Survey topographic map or on any other maps with identifiable landmarks. If assigned, the public land description to the nearest 40-acre subdivision and the assessor’s parcel number shall also be provided. (

h) As near as is known, the year in which the groundwater extraction was commenced. (

i) Any information required pursuant to paragraph (3) of subdivision (

c) of

Section 10735.2. (

j) Any other information that the board may require by regulation and that is reasonably necessary for purposes of this division or

Part 2.74 (commencing with

Section 10720) of Division 6.