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Report Number <br /> �r DETAILED DAMAGE INSPECTION REPORT Sheet <br /> U.S. DepartmentOf <br /> ofTransportaWn (Title 239 Federal-aid Highways) <br /> Federal Highway IIIIIIIIIFHWA Disaster Number <br /> Administration <br /> Location (Name of Road and Milepost) 'Fi^ by O Z <br /> Inspection Date <br /> Federal-aid Route Number <br /> Description of Damage VO ( p v 5 <br /> �lrc C' l S rPC:r� ° V �`� RJ�ir ?a P"FuR'C I CA "( F'r2s1C F. 5 State County <br /> C.br4�t4 taT CrC <br /> Cost Estimate <br /> Cost <br /> Description of Work to Date Unit Unit Price Quantity Completed . Remaining - <br /> (Equipment, Labor, and Materials) , <br /> f 1111! VAAL — <br /> Li $ <br /> kd t, r _ rs k Q 124 48 2 . ep- <br /> a t 2.dlY0.1 -GtIG� � � IG "1 I • o0 <br /> C 21 I y o0 <br /> 4 . 00 ZI17 � a IZ <br /> Ice c 0 3 2 3 7 OD <br /> w t _ sc� i . G 172014Ilo . °° <br /> C`C I y 3 32 01 �►9 48 <br /> Subtotal . 31 39a ;r <br /> Method PEICE <br /> State Forces Contras Repair Total 13139 :17* <br /> • ° <br /> Local Forces Emergency p <br /> c <br /> 0 <br /> w <br /> 0 <br /> ». <br /> N <br /> CD <br /> w <br /> r <br /> C <br /> m <br /> C <br /> a7 <br /> E <br /> a`) Subtotal <br /> Method PEICE <br /> State Forces Contract Right-of-Wey <br /> Local Forces FPerm• Repair Totals <br /> ; °; <br /> Environmental Assessment Recommendation ❑ EAlEIS Estimated Total <br /> �j313,�1a r <br /> 7K Categorical Exclusion Date <br /> FHWA Eng r � Id �✓ <br /> Recommendation Eligible Ineligible <br /> Dat <br /> State gi • G \ � /d <br /> Concurrence Yes No ('� <br /> Date <br /> op ncy R resentative <br /> Concurrence <br /> D Yes . a No : . <br /> Form FHWA-1547 (Rev. 4-98) " " <br />