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<br />~"" <br />,<,,'-' <br />/- ,.' 'c'-, <br />/ .~;,' -,' --;' <br /> <br /> <br />FEOERAL AGENCY MANAGEMENT A ENCY <br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> <br />PART I - APPLICANT INFORMATION <br />NAME OF LOCAL CONTACT <br /> <br />/}f7,..... C" <br />PART II - SITE INFORMATIO <br />KEY FOR DAMAGE CATEGORY (UH@proprfoteNIt.""n the "ca"'ory" bloclrs ".Iow) <br /> <br /> <br />.. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL FACILITIES <br />e. PUBLIC BUILDINGS <br />f. PUBLIC UTILITIES <br /> <br />/ <br /> <br />p <br /> <br />/Ju.~ ~a/ <br /> <br />SITE CATE. LOCATION (UIU! mop location, adana, etc.) <br />NO. GORY <br /> <br />MJ Ie.---u.ril f.....,..- <br /> <br /> <br />DESCRIPTION OF DAMAGe <br /> <br />~ <br /> <br />J'~ /'r~'/ <br /> <br />IMPACT: <br /> <br />SHEET -'-- OF I SHEETS <br />DATE <br />6<J, '7- R <br /> <br />PHONE NO. <br />871 - o/rJ <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON-PROFIT <br />I. PUBL.IC RECREATION <br /> <br />a..&r ..... J! <br /> <br />YG't>4?- "-"If'~ dVT--. <br /> <br />j7),.....v- ~- <br /> <br />SITE CATE- LOCATION (UIU! map location. odd,...... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />SITE CATE~ LOCATION (Use mGp locotlon. add..... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />SITE CATE- LOCATION (Use mop location, addnA, etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGe <br /> <br />IMPACT: <br /> <br />NAME OF INSPECTOR <br /> <br />.:bc.v'~ ..seA_, elf- <br /> <br />AGENCY <br /> <br />&"L? /l- <br /> <br />q/,d- ..,.."T- <br />" COMPLETE <br /> <br />'" COMPLETE <br /> <br />" COMPLETE <br /> <br />% COMPLETE <br /> <br />PHONE NO. <br />OfFICE <br />CIAI/ ?C/11 <br /> <br />ra'/T ,r,.'"Ce.._ <br />COST ESTIMATE <br /> <br />". f't:Jt7. <br /> <br />. -.:. ~ <br /> <br />.' <br /> <br /> <br />COST ESTIMATE <br /> <br />COST ESTIMATE <br /> <br />~ <br />.;l <br /> <br />COST ESTI MATE <br /> <br />I H~M.,E r <br /> <br />...., "...", <br />