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<br />COUNTY <br />R.O..... <br />POPULATION <br /> <br /> <br />FEDERA~CY MANAGEMENT AGENCY <br />PRELIMINA , GE ASSE_ENT SUMMARY <br />PAIlT I - A NT INFOIlMATION <br />NAME OF LOCAL CONTACT <br /> <br />1 <br /> <br />DATE <br /> <br />- <br /> <br />t,;t: <br />.' <br />, <br /> <br />&, -;2..7-8'</ <br /> <br />CATE. NO. OF <br />GORY SITES <br /> <br />B.lence $ Approved $ <br />PART II - COST ESTIMATE.slJMMARY (COMPLETE BITE ESTIMATE BEFORE SUMMARIZING BELOW) <br />POTENTIAL LOCAL FUNDS FOR RECOVERY <br />FUND/ACCOUNT .' AVAILABLE BALANCE <br /> <br />TYPES OF OAMAGE <br /> <br />COST ESTIMATE <br /> <br />c. <br /> <br />I <br /> <br />(1 ~ SS i#+ ... -.k__iW: e..... t- <br />jDV ~ .....J2.~<>.j <br /> <br />10/ DO 0 <br /> <br />e <br /> <br />I <br /> <br />LtJ$$ Cl ~ /9<.c.E-SS 7D 3j(~.s-r_ <br />/?,12.&U ((.JtJ-rH SI9E~) <br /> <br />S; /JOO <br /> <br />j-, <br /> <br />~.". <br />r,.- <br />\"! <br /> <br /> <br />. TcAL-Ip"DD 0 <br />,,,~ t.9J'7. <br />PART 111- DISASTER IMPACTS (USB SBl"ARATE SHEETS IF NECESSARY) <br /> <br /> <br />TOTAL <br /> <br />A. GENERAL IMPACT <br />1. Identify and describe damages wh ich constitute a health and/or safety hazard to the general publ ic. <br /> <br />J <br /> <br />, <br />" <br />f; <br />r <br />f <br /> <br />2. PopulatlClfl_V affe!:ted d1_V or ;n~v l!Vtho I'*' of public fIcllltleo or domoges. <br /> <br />3. What economic activities are adversely affected by the Iou of public f8cilities or damages? <br /> <br />B. RESPONSE CAPABILITY: Can the applicant respond and recover from the damages quickly and without degradation of public services? Describe. <br /> <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. <br /> <br /> <br />FEMA Form 90-80. JAN 84 <br /> <br /> <br /> <br />PHONE NO. <br /> <br />IJ <br /> <br />1'13 <br /> <br />:;-t ~ I <br />