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<br />Or\iG ~Jc>. JOG7.UU2~
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<br />DAMAGE SURVEY REPORT
<br />DISASTER RESPONSE AND RECOVERY
<br />(See instrucrions on reverse)
<br />
<br />3. DECLARATION NO.
<br />._"EM~..2(..2 iJ K - C cJ
<br />4. INSPECTION DATE
<br />B-8- ~
<br />5. WORK ACCOMPLISHED BY
<br />
<br />FEOERAL EMERGENCY MANAGEMENT AGENCY
<br />
<br />1, TO" P.1;GION G' FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />\ ..'_______ .___._. ..__ ___ 0 CONTRACT
<br />2. APPLICANT (St'i>{eAgency, County, City, etc.) I PA Nj I){ FORCE ACCOUNT
<br />{Q1L~ '/y 0 f ..J3o'I.jIT --'r.___Q.Z:6b!XYD,___
<br />7. WORK CATEGORY ("X" Applicable Box DSR NO. 6. PERCENTAGE OF WORK
<br />D EMERGENCY 0 A L] 8 : COMPLETED TO DATE
<br />OJ 5<i PERMANENT l1i COD 0 E l:J FOG ':::: H 0 I I 2 ~. ;-i 5 4 IT! ,5/ %
<br />
<br />S. DAr~ ide tion anddescriptionJ SA. FACILITY IN OR AiiFECTS
<br />J~.".J. r:> e Du...'" "'I" p.'S A It' ...,.,;/< p'Y ru"," FLOOD PLAINORWET LANDS
<br />
<br />r"~ y-o' ..':'.~'-:::- ~7 .. {SJ, f;:>::;r::.....~ L.l. 0 YES ~NO
<br />
<br />9 OESCRrPTIOhl OF DAMAGE ""1'(' (,1/,::,/,,11 I.,_~.-"-f......<vo.i 51"1-/,,...1 C,;.r -Y.:l"~ ';J
<br />
<br />/?1. (I (to (.. ~ J.. ~ I ^ C \or , ~ .. ~ I ~ Ily A y...( I.> J" "'" ( ~ ..: c .. '0-"--T_1. r r.. I... I / #!" " 1 rk t. f
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<br />Y',,"'d d~""""'&'1t'J """",,,~ 50"~ rh,r "-.oIl1..:',,,; (e. t lJ1(' "r-"7~',-.,,1 Ic.,c~-I,:.....
<br />t'v/v.r- 'f' .....".I.1y ~;.1 Svlf,
<br />
<br />_.J
<br />
<br />10, SCOPE DF PROPOSED WORK t 7', 4 ,'. ' ~r ..,,.,~_..,~
<br />. ,.. ,_' r , 'r' ~ .'_ r <,,>'~TF
<br />"",...t~.,,<t ,.... $'-f_b#I;J.(' rJ-ot "*"'~. (TA"-lr< ,:> "". ~5t,,",..7..f n."
<br />'" porf,l) r_p.;'t :;oot:y "ef /,/7)<'.,,,, ....,1< A,..I. ~/...I~ ,-r ,,"
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<br />U~,;, Y
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<br />11. ESTIMATED COST OF PROPOSED WORK
<br />
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<br />,
<br />
<br />
<br />MATERIAL AND/OR DESCRIPTION
<br />lei
<br />
<br />,
<br />UN11PRICE
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<br />
<br />COST (doJ(ars)
<br />leI
<br />
<br />QUANTITY UNIT
<br />lal Ibl
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<br />.~~ ~_.!-._-~~ ---------.--------------------
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<br />-~~t-,.,-----~~- ..--,.-..-.--~-----,
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<br />i----..---~--.-.-. ._....._______..u_.._.._...
<br />
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<br />,__ __~j~~__ u__u _______-=--=__1_______
<br />~~~'S;:,;~~RANCE ~Typeln _n__~==~-ff~DUNT__u _ ----i riJT~TAL ~ _ S__.. 2 ~~~~
<br />
<br />1j. HECOMMENDATION BY FEDERAL !NSPECTOR rSi(!nature Agency, dard ELIGIBLE ~ ATTACHMENTS
<br />G-_'r.-.4 8.&',8".~, ~YES[']';:;O 9,SiT.
<br />,_. ___..........E..L:L _ __
<br />-1't:-- C PORTS STATE INSPECTOR (Sig.'18(ure. Agency, dare) CONCUR ATTACHMENTS
<br />
<br />PORT BY~LCICAL-FlEP-RESEN~.ef-ll;;'~ture, A9~~~y, d!)-~g~-- - ~~~~ NO_ A TTACHMENTS-
<br />
<br />n_~_.___~___1-o:Y'-!Z.r:_~.::D NO
<br />I FEMA REVIEW (Initials f:Jnd date)
<br />8//3/lH :
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