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Project Worksheet <br />Declaration No. Project No. FIPS No. Date: Category: <br />FEMA -1.3(70 - DR- � t_ NOT .. 9 (ZZ I cl'l g <br />Applicant: County: <br />tHDIAH IZIVO— CO. I>-iDIAH RIVE2 <br />Damaged Facility: Work complete as of �I2 z���l D <br />A(-Dot-I�—S <br />I <br />Location: Latitude: N Longitude: <br />cumr r-Ot4 i C ATracHeb A44 P ) <br />Damage Description & Dimensions: . <br />EeAC4 C --Shot <br />Scope of Work: — :�Ec_ ATTAGH&D — <br />OBiA 1 H"r t-1 A U L; PL A (-( SaN b A i <br />L-AGH 'S (Te As 11t401CATl-1). DIAi S'ioNj <br />MAI VS'-`/ tJ IT- IA (tiJ CALR SI_1E <br />BASUN 0t4 IJI_t- Ot= CR OS DO 0A AAA <br />Does the Scope of Work change the pre -disaster conditions at the site? ❑ Yes 0 No <br />Special Considerations issues included? 0 Yes ❑ No <br />Hazard Mitigation proposal included? []Yes ❑No <br />Is there insurance coverage on this facility? ❑Yes ❑No <br />I I� cq� I �( �, c minc IL41 213 Cy IC - qb'6 %9 <br />I I I <br />I I I I I <br />I I I I I <br />I I I I <br />Total Cost $136, <br />Submitted By: <br />