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DETAILED DAMAGE INSPECTION REPORT <br />U.S. Department <br />of Transportation (Title 23, Federal -aid Highways) <br />Federal Highway <br />Administration <br />Location (Name of Road and Milepost) <br />12+1, S4 -rte + : • ect.b. o 27+h A -'e <br />• k-ro (beric-In Elemcn+ary. <br />a-1- 21 54-0-4 -4o 201' Ave. <br />Report Number <br />Sheet <br />1. of <br />FHWA Disaster Number <br />F L- ()Lei—Oy <br />Description of Damage <br />12ADALt6i CIA i va.s \ou-f-5 due. -}44--urriCcou�Jean'n� <br />Inspection Date <br />t0-2(o—01i <br />Federal -aid Route Number <br />State County <br />Vii. g�-fir tut, <br />Cost Estimate <br />Emergency Repair <br />Description of Work to Date <br />(Equipment, Labor, and Materials) <br />Unit <br />Unit Price <br />Quantity <br />Completed <br />Cost <br />Remaining <br />( nol't.tyv.t f r-r°pn irS <br />[,brit_ ro-t-tnrih 0-ktr-e- <br />1-r_r- rx--1-c.ck els <br />.n V\ - rti AP +2, <br />kh c i r froyi•vvt ; -h 1 (t.,011+11(✓) <br />D.5rni <br />s�- DP 27+k Aue <br />U 6eae- - Ft-rryttf o - <br />i} 2i 4(':1 ko ?n Ave <br />15 /CYn .f2 <br />10 000.'° <br />154OLD <br />Method <br />0 Local Forces • 0 State Forces <br />Contract <br />Subtotal <br />PE/CE <br />Emergency Repair Total <br />-401000.e- <br />-401000 a' <br />• <br />Permanent Restoration <br />Method <br />0 Local Forces <br />0 State Forces <br />0 Contract <br />Subtotal <br />PE/CE <br />Right -of -Way <br />Perm. Repair Totals <br />Environmetal Assessment Recommendation <br />Categorical Exclusion <br />EA/EIS <br />Recommendation <br />Eligible <br />❑ Ineligible <br />FHWAE <br />Concurrence <br />State Engineer <br />No <br />Estimated Total <br />a_12 --,,Ws (57- <br />Concurrence <br />Vies E No <br />Local Agency Re <br />esentativ <br />CX) <br />r <br />40, 000.°° <br />Date <br />t0-2(D'OY <br />Date <br />66 -�6=oy <br />Date <br />Form FHWA-1547 (Rev. 4-98) <br />