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Kepol t rvun ue, <br /> OZto <br /> DETAILED DAMAGE INSPECTION REPORT Sheet fg B I <br /> U .S. pepartment (Title 23 , Federal -aid Highways) t of <br /> of Transportation <br /> II <br /> OM <br /> Fed*ml Highway FHWA Disaster Number <br /> Administration <br /> Location (Name of Road and Milepost) <br /> Inspection Date <br /> QLl <br /> Cou + TD ri I i o � 2 L. - o <br /> Federal-aid Route Number <br /> Description of Damage <br /> It I�.�CdC3t wQ�J� � OAl .lt� '� O11 Ct7- 1'le SeaY1Y�� . State County <br /> GL gg ; OLY c <br /> Cost Estimate cWII <br /> ost <br /> Description of III Work to Date Unit Unit Price Quantity Completed Remaining <br /> (Equipment, Labor, and Materials) $ e• o <br /> .E <br /> a <br /> a� <br /> c <br /> a� <br /> rn <br /> y <br /> E <br /> W <br /> co <br /> Subtotal <br /> Method I I PENCE e <br /> ❑ Local Forces State Forces <br /> Contract Emergency Repair Total $ O� <br /> c <br /> 0 <br /> m <br /> 0 <br /> N <br /> (lDl <br /> Y <br /> C ' <br /> W <br /> C <br /> Subtotal <br /> a W, III <br /> PENCE <br /> Method <br /> State Forces ❑ Contract Right-of-Way <br /> ❑ Local Forces pew , Repair Totals <br /> Environm I Assessment R7jjecommendation ❑ EASS Estimated Total <br /> $ Ow <br /> Categorical Exclusion Date <br /> FHWA. Engine <br /> Recommendation <br /> [2e/Etigible Ineligible Date❑ <br /> State Engineer / 0 <br /> Concurrence Yes ❑ No Date <br /> Lc envy presents e 10 D <br /> Concurrence No <br /> [ Yes <br /> Forru FHWA-1547 (Rev. 4wI <br />