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Report Number <br /> rr DETAILED DAMAGE INSPECTION REPORT Fgg - 01 t <br /> U.S. Department Sheet <br /> of Transportation (Title 23 , Federal-aid Highways) , of I <br /> Federal Highway <br /> Administration <br /> FHWA Disaster Number <br /> Location (Name of Road and Milepost) <br /> FL - o '-1 - 02 <br /> T t UP i' Cpv t'1 1, Inspection Date <br /> 0q <br /> Description <br /> Description of Damage Federal-aid Route Number <br /> ri5 tnUa,l a6soC'ia41'd 40 41J m cant h anca. 5 . far i ou5 <br /> �. m <br /> I`^ e -C 2: 1 ' yy cjjC L 'A f 11 �L1C � � rC� O-CCOu f7� Gr��-} j � fi�2 State County <br /> Glu on'td <br /> FL $$ -J; rat kr� � ve �( <br /> Cost Estimate <br /> Cost <br /> Description of Work to Date Unit Unit Price Quantity - <br /> (Equipment, Labor, and Materials) Completed Remaining <br /> 2t ' r <br /> I-2 nom' a! 54 3 . 8 <br /> Va4 Ln -�- IIIPIIII <br /> vv.a,{c riot <br /> a <br /> U <br /> C <br /> d <br /> O) <br /> CD <br /> E <br /> W' <br /> Method Subtotal <br /> Op"Local Forces State Forces Contract PEKE <br /> Emergency Repair Total s} Gj 2 9 <br /> C <br /> 0 <br /> m <br /> 0 <br /> N <br /> d <br /> of <br /> w <br /> C <br /> m <br /> C <br /> d <br /> a <br /> Method Subtotal <br /> PEICE <br /> Local Forces State Forces Contract Right-of-Way <br /> Perm. Repair Totals <br /> EnAronntal Assessment Recommendation t1tJ <br /> [✓Categorical Exclusion ❑ EAIEIS Estimated Total —t 1 .72 3 <br /> Recommendation FHWA Engineer Date <br /> Q Eligible Ineligible r 10 <br /> Concurrence State Engineer Date <br /> Yes No <br />' Concurrence' Local Agency Represen 'vaDat <br /> ^ e <br /> a Yes INo- <br /> Form FHWAA547 (Rev. :4wS8) : <br />