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Report Number <br /> �W DETAILED DAMAGE INSPECTION REPORT Sheet 001 <br /> � <br /> u.s. DePa <br /> rT18^t (Title 23 , Federal-aid Highways) of <br /> of TransPortation <br /> Federal Highway FHWA Disaster Number <br /> Administration <br /> Location (Name of Road and Milepost) ( L <br /> Inspection Date <br /> V" l <br /> Federal-aid Route Number <br /> Description of Damage ,�(� � ( p u S <br /> St �Cif� T>Ar 46bc ftwe State County z <br /> 'QAC-4E "C^ L <br /> 4 <br /> Cost Estimate <br /> Cost <br /> Description of Work to Date Unh Unit Price Quantity Completed Remaining <br /> (Equipment, Labor, and Materials) <br /> S rc�t..t - PEN <br /> c <br /> CL <br /> m <br /> Cr. <br /> c <br /> CD <br /> E' <br /> a) <br /> E <br /> W <br /> Subtotal 1 <br /> Method PENCE <br /> Contra <br /> State Forces [� il <br /> .Local Forces .Emergency Repair Total / / D Dom• <br /> c <br /> 0 <br /> ns <br /> 0 <br /> u, <br /> tr <br /> c <br /> C <br /> c <br /> C0 <br /> a' Subtotal <br /> a <br /> Method PENCE <br /> Local Forces <br /> State Forces ❑ Contract Right-of-Way <br /> Perm. Repair Totals <br /> Envir nmental Assessment Recommendation Estimated Total <br /> Categorical Exclusion ❑ EA/EIS FHWADate <br /> .En ar � 6 '� c.f <br /> Recommendation <br /> X1 Eligible Ineligible Dat <br /> I III Ste ngin �o G p l� <br /> ConcurrenceFOI Q No .� <br /> Yes Lo en Represent five Dat <br /> Concurrence. . <br /> �] Yes, .�] No . . . _ - - . . . • - '' , _ , � . . , <br /> Form ;FHWA='f 5V. ( Rev: <br />