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Form FHWA-1547 (Rev. 4-98) <br />Report Number <br />. <br />cab- DETAILED DAMAGE INSPECTION REPORT <br />S B'$ - 03 1 <br />U.S. Department <br />of Transportation (Title 23, Federal -aid Highways) <br />Highway <br />Sheet <br />f of 1 <br />Federal <br />Administration <br />Location (Name of Road and Milepost) <br />h <br />FHWA Disaster Number <br />L, - oy -ou <br />12-4 AU e mid oc-1- S.2'd n(� <br />l�V�1'ty� <br />Inspection Date <br />IO-2Zlo—o4 <br />Description of Damage <br />(Load5 cle wa51A0U+ -11,a:1- uincl. rwl;inc. d ordr-a;I. <br />Federal -aid Route Number <br />• <br />State County <br />Cost Estimate <br />Emergency Repair <br />Description Work to DateUnit <br />Cost <br />of <br />(Equipment, Labor, and Materials) <br />Unit Price <br />Quantity <br />Completed <br />Remaining <br />Qr'YIALU e.q rzpra t r <br />n ' <br />$ s, non � <br />Method Subtotal <br />. <br />5/000. 'r' <br />PE/CE <br />C <br />Local Forces State Forces ontract <br />Emergency Repair Total <br />i . o •00. vo <br />c <br />0 <br />o` <br />. <br />to <br />IX <br />'"E' <br />c <br />E. a <br />a) <br />in. <br />Subtotal <br />Method <br />PENCE <br />Local Forces E State Forces D Contract <br />Right -of -Way <br />' Perm. Repair Totals <br />Environmen ssessment Recommendation <br />ategoricai Exclusion <br />' <br />EA/EIS <br />Estimated Total <br />-rp <br />S0 00 <br />Recommendation <br />ligible Q Ineligible <br />FHWA En a <br />� (1 <br />Date <br />to -2-6-04 <br />Concurrence <br />[fes E No <br />State ngineer ` <br />lam— <br />Date <br />-715-04, <br />Concurrence <br />eyes No <br />cal Agency presents v 1 \ <br />W s �,-J0 <br />Date <br />J0 - Zb'-' 0 4 <br />Form FHWA-1547 (Rev. 4-98) <br />