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Report Number F <br /> 17M <br /> DETAILED DAMAGE INSPECTION REPORT Sheet of(Title 23 , Federal-aid Highways) <br /> Fsds rig Y <br /> Adml on FHWA Disaster Number <br /> Location (Name of Road and Milepost) FL - DH - 0`1 <br /> Inspection Date <br /> t t O <br /> SnC1 i �i u Y moun - (� <br /> `1 Federal-aid Route Number <br /> Description of Damage I - , (ar �U,�j <br /> 61 n d.ar;na e C�.t L T ruYr i C'Q � e 1-r�t n c � S • State County + <br /> MC 4-C Po(- occwt - �FL gg - �irY� ton t Y }` <br /> Cost Estimate <br /> Cost <br /> Description of Work to Date Unit Unit Price Quantity Completed Remaining <br /> (Equipment, Labor, and Materials) <br /> l0 2 � •de <br /> o +r V (w 11 100 000 <br /> I 5 <br /> CL ano <br /> CD <br /> tY <br /> U <br /> C <br /> m <br /> d <br /> E <br /> W <br /> Subtotal 2 <br /> Method PENCE <br /> �ocal Forces State Forces Contract <br /> Emergency Repair Total 00 • ' <br /> f <br /> c <br /> 0 <br /> m <br /> 0 <br /> y <br /> C <br /> C � <br /> C <br /> CD <br /> a Subtotal <br /> Method PENCE <br /> Local Forces State Forces Contract <br /> Right-of-Way <br /> Perm. Repair Totals <br /> 00 <br /> Environmprftl Assessment Recommendation A/EIS 3D 3 <( Q . <br /> Categorical Exclusion ❑ EEstimated Total <br /> Date <br /> Recommendation FHWA Engineer 10 _ to _ p y <br /> Eligible E] Ineligible <br /> Elie Date <br /> ConcurrenceState Engineer <br /> to 11111116 —CJ c� <br /> Yes ❑ No Date <br /> Concurrence oval Agency Repr entati ` 0 <br /> Yes C No <br /> morm FHWA-1547 (Rev. 4-98) <br />