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Contract#28223 <br /> Item or Referral No. <br /> Station or Well No. <br /> ATTACHMENT B <br /> GENERAL PURPOSE FIELD INVESTIGATION FORM <br /> Reported By: Phone: <br /> Well Owner Name&Address: <br /> Phone: <br /> Well Location: <br /> GPS Position: <br /> (Lamudc) (Longitude) <br /> GPS Datum(circle one): NAD83 WGS84 <br /> Date of Inspection: Observed By: <br /> Cost Share Program discussed: <br /> Well Diameter: Well Depth: 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 96 <br /> 5;15,15 <br />