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Report Number <br /> O <br /> DETAILED DAMAGE INSPECTION REPORT sheat 8r — p21 <br /> U.S . Department (Title. 23 , Federal -aid Highways) _� of I <br /> of Transportation <br /> Federal Highway <br /> Administration FHWA Disaster Number <br /> Location (Name of Road and Milepost) <br /> u Inspection Date <br /> LoIIIIIIIII0 <br /> Federal-aid Route Number <br /> Description of Damage <br /> QjIIAWILI U jo-S� "LI OLLI 4-0 <br /> state County <br /> FL gg - z►� ltar, �.,�� <br /> 1 Y <br /> Cost Estimate <br /> Cost <br /> Description of Work to Date Unit Unit Price Quantity Completed Remaining <br /> (Equipment, Labor, and Materials ) 11,% <br /> CL <br /> ICU <br /> U <br /> C <br /> Q) <br /> 21 <br /> a) <br /> Q) <br /> E <br /> LU <br /> Subtotal Do • v� <br /> MethodPEI <br /> Local Forces State Forces E500contract <br /> Emergency Repair Total 0 <br /> c <br /> 0 <br /> w <br /> co <br /> 0 <br /> rn - <br /> m <br /> ,r <br /> c <br /> m . <br /> c <br /> co <br /> CD Subtotal <br /> Method PEI <br /> Local Forces [] State Forces [] Contract Right-of-Way <br /> Perm. Repair Totals <br /> Environmen I Assessment Recommendation ❑ EA/EIS Estimated Total �o ' <br /> []Gtategoric11 al Exc11 lusion FHWA Engin Date <br /> III <br /> RecommendationU <br /> Eligible Ineligible Date <br /> Stat ng neer �� .Z(� <br /> Concurrence � / No v. L� <br /> lam' as Date <br /> Lo gency R reser <br /> Concurrence <br /> 2/yes No <br /> Form FHWA-1547 (Rev. 4-g8) <br />