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ATTACHMENT B <br />GENERAL PURPOSE FIELD INVESTIGATION FORM <br />Reported By: Phone: <br />Well Owner Name & Address: <br />Contract #28223 <br />Item or Referral No. <br />Station or Well No. <br />Phone: <br />Well Location: <br />GPS Position: <br />(Latitude) (Longitude) <br />GPS Datum (circle one): NAD83 WGS84 <br />Date of Inspection: Observed By: <br />Cost Share Program discussed: <br />Well Diameter: Well Depth: <br />Taped/reported Blocked C feet <br />Well Status: (Check All That Apply) <br />Accessible By: Well Head: Condition: Action: Loggability: <br />Foot Visible Capped Left As Found Loggable <br />Vehicle Buried `Valved _Temp Plug _Site prep required <br />Boat Discharge Visible Only Leaking Temp Repair Need: (prep work) <br />Not accessible Under power lines Flowing _Flagged or Staked <br />Unable to locate Other Not Loggable <br />Reason Not Loggable: <br />Flow upon arrival gpm <br />Flow wide open gpm <br />Flow as left gpm <br />Recomendation: <br />Owner Keep _ Owner Repair,'Abandon Not Repairable SJRWMD Repair Abandon <br />Comments: <br />Attach photos <br />Version 1.6 <br />5;1515 <br />