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Report Number <br /> �r DETAILED DAMAGE INSPECTION REPORT ocpt <br /> U.S. Department Sheet <br /> of Transportation (Title 23 , Federal -aid Highways) <br /> Federal Highway of <br /> Administration <br /> Location (Name of Road and Milepost) FHWA Disaster Number <br /> oc� - O Z <br /> ICkvc— o2 coa >`rt �( - C�C.C1�1 � I - 144t I J inspection Date <br /> l o f,o Z <br /> Description of Damage Federal-aid Route Number <br /> �yACJwa�� <br /> 'De <br /> State . County <br /> Cost Estimate <br /> Cost <br /> Description of Work to Date Unit Unit Price Quantity <br /> (Equipment, Labor, and Materials) Completed Remaining <br /> � Al <br /> � ab0 <br /> a lr <br /> a <br /> ID <br /> W <br /> U <br /> C <br /> m <br /> m <br /> E <br /> LU <br /> Method Subtotal <br /> Local Forces State Forces Contract PEICE <br /> Emergency Repair Total } <br /> c <br /> 0 <br /> L° <br /> 0 <br /> m <br /> c <br /> m <br /> c <br /> co <br /> E <br /> a� <br /> CL <br /> Method Subtotal <br /> PEICE <br /> Local Forces Q State Forces ❑ Contract Right-of--Way <br /> Penn. Repair Totals <br /> Environmental Assessment Recommendation I ,,`, ��f�9 <br /> 'Categorical Exclusion ❑ EA/EIS Estimated Total �'i ���" <br /> Recommendation FHWA nine Date <br /> Eligible Ineligible t ICA,( <br /> Concurrenceto Eng l er <br /> es No D /014g JOH <br /> Concurrence Local gency R presentative Date <br /> Yes No <br /> Form FHWA-1547 (Rev. 4-98) <br />