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Report Number <br /> DETAILED DAMAGE INSPECTION REPORT Tat - O29 <br /> U .S. Department <br /> of Transportation Title 23 , Federal-aid Highways) sneer <br /> Federal Highway ( of <br /> Administration <br /> Location (Name of Road and Milepost) FHWA Disaster Number <br /> '17 1011'` 75+y-oe t� ( ct - ark west o� Co t� ^ }4vevwc.) fir✓- oq - 04 <br /> Inspection Date <br /> f <br /> Description of Damage Federal-aid Route Number <br /> R.ax .�ci� wa.51Ao Lj�+ . <br /> State County <br /> Fr✓ g F Tye; an Relar <br /> Cost Estimate <br /> Description of Work to DateCost <br /> Labor, and Materials Unit Unit Price Quantity <br /> (Equipment, ) Completed Remaining <br /> (p ppO • °' <br /> a <br /> c <br /> d <br /> rn <br /> a� <br /> E <br /> LU <br /> Method Subtotal <br /> Local Forces State Forces 00OCantract PEKE <br /> Emergency Repair Total r° <br /> c <br /> 0 <br /> w <br /> E <br /> 0 <br /> N <br /> w <br /> C <br /> CD <br /> C <br /> M <br /> G <br /> CD <br /> IL <br /> Method Subtotal <br /> Local Forces Q State Forces Contract PE/CE <br /> Right-of-Way <br /> Perm, Repair Totals <br /> Environme ssessment Recommendation <br /> Categorical Exclusion Q .EA/EISEstimated Total (O , OOO ' <br /> RecommendationFHWA Engineer Date <br /> Eligible Ineligible � ' 1 D � Zto —o`•( <br /> Concurrence State Enginee Date <br /> E'es No <br /> ConcurrenceLo ency R resentativ Date <br /> Yes ❑ No (iCJ� p - i 40 Z ' O <br /> Form FHWA-1547 (Rev. 4-98) <br />