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do <br />Derailed Damare Inspection Report <br />(Title 23, Fe..:ral-Aid Highways) `S.!:CT 0,_. <br />LOCATION (NAME OF ROAD AND MILEP03T) — 013A3TEq NU1-I8ER <br />V I�R•OJ 5 n1 T �_ o,.•, C. r. i ••I I 1111rCTi01 ATE <br />DESCRIPTION OF DAMAGE (ATTACH SKETCH) <br />FeoeRAL•AlD ROUTE INur+BER <br />1rnrG1L ��c Aln` �nrnnGIL <br />COUNTY <br />�J \aP_c:�,� <br />ZrJ p, A..1 '�1V Com` <br />i, <br />DESCRIPTION OF WORK <br />CoulA IENT, LAA -Orr ANO Al .-ErpgL$ <br />UNIT _- COST <br />QfY PINCL COMPLETED REFIAININO <br />—.--_ <br />1'� -i �1 l� S 1 (�.I 4 l I .•t1 r <br />—_—. _ _ ��...._---_.—_ ___. .. . <br />.C�_1�i_^ILI <br />N <br />Fl - <br />I <br />LAS-L—Q_1C�N£.An SIc��, c.z�nl—___1t3�i�25Z! <br />Q-- — -- <br />-�-- ------.. <br />I I— - - <br />METHOD O LOCAL FORCES O STATE FORCES <br />D EM Eq GCNCT CONTRACT SUBTOTAL l l U U 01 <br />EMERGENCY REPAIR TOTAL �• <br />I I � <br />_ I I <br />T <br />I <br />I I _— <br />METHOD O LOCAL FORCES O STATE FORCES O LOW BID CONTRACT i PERM. REPAIR TOTAL <br />I PE/CESI (250/6) <br />ENVIRONMENTAL ASSESSMENT RECOMMENDATION RIGHT•OF'Y/AY <br />NOT REOUIREO O MAJOR ACTION O NONMAJOR ACTION Ea71?tATiD ICTAL <br />R COMMENDATION • FHWA ENGINEER DATE• <br />ELIGIBLE O INELIGIBLE Z. $ <br />7,1 <br />CONCURRENCE - STATE ENGINEER /T DA E <br />WYES O NO A/�Gi C/—�lJ--v` --_- __ --x-- — <br />CONCURRENCE - LOCAL AGENCY REPRESENTA DATE <br />XYZ3 13 1,10 ao/lizai- <br />1 547•A.WPO <br />AUO 1 <br />