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<br />
<br />FEDERAL e:MERGENCV MANAGEMENT AGENCY
<br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
<br />
<br />PART I - APPLICANT INFORMATION
<br />
<br />5l:.tF 1.?~~~;NTef U);~ /;{~ NAME OF LOCAL CONTACT
<br />
<br />PART II - SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (U.e appropriate lett.,.. in the "category" bloclr, below)
<br />
<br />SHEET
<br />DATE
<br />
<br />OF
<br />
<br />SHEETS
<br />
<br />".
<br />
<br />PHONE NO.
<br />
<br />8. DEBRIS REMOVAL
<br />b. PROTECTIVE MEASURES
<br />c. ROADS AND BRIDGES
<br />
<br />d. WATER CONTROL FACILITIES
<br />eo PUBLIC BUILDINGS
<br />f. PUBLIC UTILITIES
<br />
<br />Do FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON-PROFIT
<br />I. PUBLIC RECREATION
<br />
<br />SITE CATE- LOCATION(U"l"aplpcotio~odd1"","c')J A' . f W..... w.. '''-t!!'#-.
<br />NO. GORY Adj'e......-t- -('0 <.:".,.,... ".~.... T'. '::'0_ ,/ -/
<br />I A V/Jofe/~ J C~;C4d-. S..e /0 e4 ,......""... -'I' nrTAU,-'6...
<br />
<br />DESCRIPTION OF DAMAGE e -e;S /7CGU ""'" ';1;0 j..J , ,~ JI~~ "'~69-. l!"....e<l!.
<br />IJ IlDvIf I 11I1c.~ "Jfe ~ WJtr,J ;~f! ~ C 4-r ./ /'" -/ p ps-tf. ~.... . t!' #!t .1' ,,0 r /,4
<br />;{~su//" 7' fJr!J,..;I;;.., ;'7- -I'~ COh~l'.I,. Jt.v:'''J- cI~/9sJ~./ ""A.-4#~ .
<br />cf, J,.' ..., g., .J'''''~ C 5;17. Jp.,J ~ 7""-'($) w. t'~,~ q-~ /h~ ~M...
<br />;>-I::"'~d 7oq,ooo c. / or "..;/ rle.Jlt/r <<JAr 4<yos;7"./. .
<br />IMPACT' t1 e 1..1 ., $,' /'. of' "oS 't!'#f. (J j "COMPLETE COST ESTIMATE
<br />"'f!~,.~ JH,f Jue..eCf,:..o /~~ 1'001 S'cc.//AW';;; , /"7 II 75 ~ 500
<br />A eM ./ " ~--r....t' /3.:...e , '1iik yIi,,, t: ,r;.;" l./
<br />SITE CATE- LOCATION (U.e map locaHon, aC:IdreN, etc.) We,,' -e- OS'
<br />NO. GORY
<br />
<br />
<br />0/"4"
<br />
<br />.
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />SITE CATE- LOCATION (U.e mop location, oddre... etc..)
<br />NO. GORY
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />% COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />SITE CATE- lOCATION (Use mop location, odd,.e... etc.)
<br />NO, GORY
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />% COMPLETE
<br />
<br />COST ESTIMATe
<br />
<br />NAME OF INSPECTOR
<br />A~.v "'4<LT"'~".QO
<br />? 'Ir'" ,J./~l""""
<br />
<br />AGENCY
<br />
<br />1>WI~ , COLD
<br />_ .~ _ / ,n <
<br />
<br />PHONE NO.
<br />~FFI,CE, ,......~~~OME
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