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�'• <br />s' DETAILED DAMAGE INSPECTION REPORT <br />U.S. Department <br />Form <br />Report Number <br />S g• 3 - p 25 <br />of Transportation Title 23, Federal -aid Highways)Sheet <br />Federal Highway <br />1. of —L <br />Administration <br />Location (Name of Road and Mllepost) <br />FHWA Disaster Number <br />-Ou <br />20"'Auentke Cao.+h 0 F 5-a+c ��V�Ut J Q <br />, <br />-0 <br />Inspection Dae <br />I 0 ZCo — WI <br />Description of Damage <br />11,004,00.d damac cs eluL c 1 Y Sea nne • <br />Federal -aid Route Number <br />Ova lane. Luctd <br />State County <br />RL B 2-Ird.an Rwer <br />Cost Estimate <br />Description of Work to Date <br />Unit <br />Unit Price <br />QuantityCost <br />(Equipment, Labor, and Materials) <br />Completed <br />Remaining <br />P n/rd wct_ L r -t. ,i i i'S <br />.B 1 S °' <br />iC00. <br />kink- : arc were flour log ,: <br />,_ <br />.Q <br />Lth*-h I/y rn i le -M P r rr (-i- <br />CC <br />Citi he erY1Siott rr.d. OS Melt <br />N TC. . <br />a) <br />EP <br />m <br />E <br />w <br />Method Subtotal'?9 <br />'� <br />i S oo. <br />Local Forces fl State Forces 'ontract PEJCE <br />fr) <br />Emergency Repair Total <br />$ i Sx000 .''v <br />c <br />0• <br />o <br />11) <br />. <br />m <br />.r <br />c <br />a) <br />c <br />m <br />ti <br />Method Subtotal <br />PEJCE <br />Local Forces E State Forces 0 Contract <br />Right-of-Way <br />Perm. Repair Totals <br />Environmentssessment Recommendation <br />categorical Exclusion <br />• <br />•EA/EIS <br />Estimated Total <br />4o0 <br />15 iSTO 00 . <br />Recommendation <br />ligible Ineligible <br />FHWA Enginee <br />Date <br />tD-2tc -0t-(Concurrence <br />LJ es No <br />State Engineer <br />Date <br />/Q --ar-ol <br />Concurrence <br />COYes ❑ No <br />Local Ag cy Repres ntative <br />fl-) . -t <br />Date <br />/0 -Z-C-0/- <br />ZG-O/ <br />Form FHWA-1547 (Rev. 4-98) <br />