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<br />" PRE'~IMI~~H.MA~~ A~~;SS~E~~SU~~~RY
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<br />~' -.r APprO...ed~ aalane. $ . -APpro.~~ Balance $
<br />PART" - COST ESTlMATE.SUMMARY (COMPLETE SITE EST1.\fATE BEFORE SUMMARl:t:.lNG BELOW)
<br />POTENTIAL LOCAL FUNDS FOR RECOVERY
<br />FUND/ACCOUNT _' AVAILABLE BALANCE
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<br />DATE FV BEGINS
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<br />PART III - DISASTER IMPACTS (USE SEPARATE SHEETS IF NECESSARY)
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<br />TOTAL
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<br />A. GENERAL IMPACT
<br />1. Identify and describe damages which constitute a health and/or safety hazard to the general public.
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<br />~ ;i2._,::"a::,~~y affected di,":"IY or indirectly by the loss of public faci~~tias or '1-"__.,:':. .
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<br />3. What economic activities ere adverselv affected by the loss of public facilities or damages?
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<br />B. RESPONSE CAPABILITY: Can the applicant respond and recover from the damages quickly and without degradation of public services? Describe.
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<br />C. IMPACT ON PUBLIC SERVICES IF DECLARATION IS NOT MADE: e.g., Deferral of permanent repairs, impact on ongoing services and capital
<br />improvements. etc. Describe.
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<br />FEMA Fonn 9~O. JAN 84
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