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Home My WebLink About650194.tiffBefore Completing This Application, See Instructions. STATE PROJtaJ NO. G.A (State to enter) PROJECT APPLICATION FOR SUPPLEMENTAL FEDERAL FINANCIAL ASSISTANCE (UNDER PUBLIC LAW 875, 81st CONGRESS, AS AMENDED) Date of President's Major Disaster Declaration 3 n s 19, lei 1. General Information: (To be completed by applicant) f _ 2. Financial Information: (To be completed by applicant) a. Estimated costs of this disaster to be paid by applicant: $ 1at>,roylon (Not including requested Federal assistance) b. Total Federal financial assistance requested in this application (from Exhibit "B")' $ 171,496.00 — a. State of b. Applicant: Coilora.In meld County County of Weld Applicant's Local Proj. No. 1 Address: orse s, n_,s_ado c. Is applicant other than a State, county, city, village, township, or school district? If so, attach information to this application in accordance with art 2 of Instructions. d. Official representative of the applicant: (Named in Exhibit "A") Name: Address: ileer L. Shultz WeldiiCccw4GC1 yCouxtbsues e, Basic Catprede eegeoer3�s•of Work(Categories listed in Exhibit "B"): _ Title: f. Type of Disaster: ?load Phone: r%slrs>.a, Wawa ep r is n+y Cesnissloner 239-2242 sat 21 (flood, fire, hurricane, earthquake, storm, etc.) Occurring on or about: ,jun. 14.9 , 1t4.9 (Date) 3. Summary: (To be completed by OEP) OEP Project No. 2pyj_„__ a. Received in OEP Regional Office on (number) An14 e (date) b. Amount requested by applicant c. Amount approved by State d. Amount approved by OEP $ 1q snail* Lavin On Form OEP 152 April 1965 C fin fr�fl�l� page 01 g CAIn, Page } of 7 4. (To be completed by applicant) THE APPLICANT HEREINBELOW DESIGNATED makes application to the GOVERNOR OF THE STATE for the sum stated in paragraph 2.b of this application to cover estimated Federal costs of the work described in EXHIBIT "B" attached to this application. These funds are to be paid from the Federal Disaster Fund made available under the provisions of the Federal Disaster Act (Public Law 875, 81st Congress; 42 U.S.C. 1855-1855g), by order of the President of the United States of America, and to be spent in con- formance with the Federal -State Disaster Assistance Agreement between the United States of America and the State. ASSURANCE AND AGREEMENTS A. The applicant certifies that the disaster relief work herein described for which Federal financial assistance is requested hereunder, has been determined necessary and essential in accordance with the criteria contained in Section 1710.10 of the Federal Disaster Assistance Regulations. B. The applicant is the legal entity responsible under law for the performance of the work herein detailed. C. The applicant represents that to the best of its knowledge and belief this Project Application meets all of the requirements and conditions of the Federal -State Disaster Assistance Agreement. D. The applicant certifies that all information given by it herein is, to the best of its knowledge and belief, true and correct. As the duly authorized representative designated by thelloard of County Crds- (Governing Body)! Mere of Veld County, Caisrade , as attested by a certified copy of (Applicant) the instrument attached as EXHIBIT "A" hereto authorizing this application, I have caused to be drawn and herewith submit this application for disaster assistance, agreeing that all parts and provisions of this instrument shall be binding upon the use and/or expenditure of any funds allocated. WITNESS: County Clerk t Recorder Deputy County Clerk SIGNED: Chairman, Board of County Co®mis!!'oners Applicant's Authorized Representative Date: August 4, 1965 Form OEP 152 April 1965 Page 2 of 7 5. (To be completed by State) JOE c, vir , (or his authorized represen- tative) OF THE STATE OF having reviewed this application submitted by the local government instrumentality herein designated, and having found it eligible for approval on the basis of the attached report marked EXHIBIT "C", do hereby approve the said application in the amount of $i'j(- * 0 • * s x • a * * , and do further recommend approval by the Office of Emergency.,Planning in the amount stated, for the purposes and amounts applicable to such purposes as set forth in the Exhibits attached hereto, and certify that all fincial assistance received under this application will be, or has been, a nded in accordance with applicable law and regulations thereunder Date: 6, (To be completed by OEP) OEP Project No,* � STATE of is hereby �) (prov'figia y approved) in ac-coroance with the provisions and conditions attached hereto; and disbursement of Federal funds is authorized in an amount not to exceed $aa.pocao for this project in accordance with the Federal is ster Act (Public Law 875, 81st Congress; 42 U.S.C. 1855-1855g), and the Federal -State Disaster Assistance Agreement entered into on the leek day of 1945_, by the United States Government and the state. Date: AUG 1 91965 /s/ Regional Director, RegStn • Office of Emergency Planning Form OEP 152 April 1965 Page 3 of 7 APPLICANT Weld County, Colorado STATE NO. C+29 OEP NO. 200 -29 WHEN PROVISIONALLY APPROVED BY THE REGIONAL OFFICE DIRECTOR, THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT AND THE STATE: 7. I yri_d 7/ n ed in EXHIBIT "A\" do hereby acc t on behalf of the applicant the provisional approval of $ /Z, 4 44,00 by the Regional Office Director, OEP: Date AUG 2 6 1964 Is! , the authorized representative A•plicant's Aut •rized Represen ative Chairman of the B 8. I, .792 C. 11171?! Representative) do hereby accept approval of 966 OEP. ,(or Authorized on behalf of the State the provisional $ 166. .00 ♦ A * * *by the Regional Office Director, Date 10Avast 1965 /s/ L rrr or Authoriz:i Representative >a uu. Drawn $oonlI A2CI (Note: This sheet is to be detached by the Regional Office when the application is approved as submitted,) Form OEP 152 Page 4 of 7 April 1965 EXHIBIT "A" RESOLUTION Attachment for Application No.1 BE IT RESOLVED BY OF , �� ssi .� THAT to r L. fOWASZof Incumbent) ritlfritit ikon) be and he is hereby authorized to execute for and in behalf of , a public entity established under the VW S4"Y*! State of , this application and to file it in the appropria'lrellig office for the purpose of obtaining certain Federal financial assistance under the Federal Disaster Act (Public Law 875, 81st Congress; 42 U.S.C. 1855-1855g). Passed and approved this 40, day of August , 19 _. I' Ann $pc.sr of , do and correc cop o a resolution Name and Ti �1[e 'Chairman, arstlof Countysnissianars Name and Title Member Name and Title CERTIFICATION , duly Ilest#0strgitttiocyri appointed and > nnatior le hereby certify that the above is a true passed and approved by the esiunna• OF litpGbSiitity) _ day of . _•st , 1963 IM WY ) ate Date: Adgust 4, 1966 Form OEP 152 April 1965 c a s> ion) on the (Signature) NOTE: If the applicant is a Sta1L2 agency,"a letteriepu y County Clerk from the agency head designating his authorized representative should be inserted in lieu of this EXHIBIT "A") Page 5 of 7 EXHIBIT "B" DETAILED PROJECT ANALYSIS APPLICANT Mold County, Colorado Local Project No. 1 Attached hereto, as identified below, are detailed descriptions of the items of work to be performed by the Applicant, and estimated costs (to the nearest dollar) for each item of work for which Federal financial assistance is requested. A separate attachment is included for each of the basic categories of work for which assistance is requested. The total of work described in all attachments is the amount of Federal financial assistance requested in the above referenced project application. The applicant will complete the following form only for those categories for which Federal assistance is requested. Category No. A. e -- B. Basic Category of Work Amount Requested Debris Clearance c Protective, Health and Sanitation Measures C. Streets, Roads and Bridges D. Dikes, Levees, and Drainage Facilities E. Public Buildings and Related Equipment F. Public Utilities TOTAL . . . . . Form QEP 152 $ 0,550.00 6,426.00 150,631.00 440.00 • • • • • • • • ' • 171,046.00 Chairman, Board of County Commissioners Wild County, Colorado Representative) Page 6 of 7 April 1965 EXHIBIT "D" ASSURANCE OF COMPLIANCE WITH OFFICE OF EMERGENCY PLANNING REGULATION 5 UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 OEP Project No. 200 -*-29 Local Project No. Weld County. Calo:adr (hereinafter called the "Applicant") (Name of Applicant) HEREBY AGREES THAT it will comply with title VI of the Civil Rights Act of 1964 (P.L. 88-352) and all requirements imposed by or pursuant to Regula- tion 5 of the Office of Emergency Planning (30 F.R. 321) issued pursuant to that title, to the end that, in accordance with title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant received Federal financial assistance from the Agency; and HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to effectuate this agreement. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Agency, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal finan- cial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. In all other cases, this assurance shall obligate the Applicant for the period during which the Federal financial assistance is extended to it by the Agency. THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, reimbursements, advances, con- tracts, property, discounts or other Federal financial assistance extended after the date hereof to the Applicant by the Agency. The Applicant recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this assurance, and that the United States shall have the right to seek judicial enforcement of this assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Applicant, Dated Amu* 4. 1946 Weld County. Colorado (Applicant) Byignature of Ap licAuthor zed Represe tative) Chairs. Board of County Cirrtaalooro Form OEP 152 April 1965 Pr 061 ('-.‘ WELD, COUNTY, COLORADO Category "A", Debris Clearance I concur with the 1W, PR debris clearance estimates as contained in the attached reports; Items 11 23 28 37 38 40 42 43 44 46 47 1100 100 900 550 500 900 400 500 1,000 550 rLI ;r s Pager et County Commissioners 00unty, Colorado Weld County, Coloreds, continued Category Rt Protective, Health I Sanitation Item 1. Channel clearance to protest County Road (see sHD/RPR report, item 46 attached) $1,600.©0 Item 2. Channel clearance to protect County Read_ (see sVD/NM report, item 43 attached) 300,00 Item 3, Protect roads I bridges (sae Corp of Engineers report dated July 13, 1864 attached) I concur with the attached aND/RPR and Corps of Engineers reports as cited above, AuCifsrise�e Repress': vs, Choi Beard of County. 'donors Page IS tit* Weld County, Colorado, continued Category Cs Reads, Streets and Bridge', I concur with the attached S!D/8PR cost estimates as contained !nibs attached reports, items 1 thru 47 (debris Clearance sort estimates have been included under Category "A" and Protective Work under Category "B") 1158,631.00 rimed Repress n tive, rman, Beard of County Contest page #9 DATE . DECLARATION _FORM PR -;13F --A' (REV. 7.091 U.S. OEPA'i'1PEIrT OF CGM7lr '^3 ! REGION NO. nun EA'J or fUnLiC I: G, ':v:.: ACTION �CTO ftli',.;:R≥:NCE 6NITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23-2) STATE. s. COUNTY ..• E; .:'iERCc.NCY O TEMPORARY O DEBRIS O GRANT IN .:PAIR REPLACEMENT CLEARANCE LIEU JURISDICTION GQ!/j7 ��.i INSPECTION ir,ADE BY REPRESENTING STATE OR PROJECT NO. ITEM OR REFERENCE: 1i0. / `�� 1 /./ G.� .' r..�' I C. n. DESCRIPTION pidOF DAMAGE / L id. /7OLi C. J Lt�Cty :At." O.a ^1 0 11 3C•r I..: i -:/ tie/rJ�'�'Y f:ne/ra -,;/..v/: G7: y //•• 1,,i; 44r. ..; c^ ..,..rv,--, Lc,- •1-r—' C rc i rC ORIGINAL. FACILITY • SURFACE TYPE GI^ct✓e i • Ai.i• '' oAD OTHER (gpeelty) p BRIDGE O FACILITY TYPE % f 00 ', z'in„e C o RC/i ROAD BRIDGE OTHER LENGTH' f SURFACE WIDTH 1 le /1 t LENGTH (Overall) :WIDTH (Curb fo curb) I 1 I •.HEI6HTI LENGTHI WIDTH, OIAM£T'cR: r4 1 ELIGIBLE INELIGIBLE (Olva ) nECOMMENDED WORK Kn.t�fit u�.t Add ,,e! b 5Ltac(IIq DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE C. G il�,Cjr"Jri /� l�r"J `o - COSY SIGNATURES (inepectlnj Eng,neere) (9 PR) TOTAL ESTIMATED COST Tao IF MORE SPACE.IS'REQUIRED UREVERSE SIDE OR SEPARATE SHEET T ti4� (.,!e'✓�r1�4F . C.. 1:A.- :/ 4:I..'' USCOMM•DC 9030•,':, .; DA•Ta, or DECLARATION _ / (- L. I FORM PR -113r--, U.S. ()EPA PTMENT OF COMMF.ECE i (REV. 7 -Os) nuItr A., or PUnt.FC R ,S INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM ?3-?) REGION NO. el t 1 I� aAT OF INSPECTION � I ". STATE / c:, .a �...� VF'v':J %7i FtR6NCE lJ COUNTY / /r / / ri EMERGENCY [-:_i TEMPORARY O DEBRIS GRANT IN ' REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JURISDICTION .--.10...i , .r INSPECTION MADE BY REPRESENTING L G, >>> , )3 Fitz, STATE OR PROJECT NO. I ITEM OR REFERENCE NO. 5 Ifi 2. fit`-- f DESCRIPTION OF DAMAGE • v.',CA 006+,wallsI� a S 1, rd a.,:k 4.4 a; .. _ p ri ! J ,brlc 2clf $/n", of Br-+o(ti-i- • :` ': 3.,1.\)'•,((v na. r- C �� LOCATION , — .one, or E' a'I O R ' ORIGINAL FACILITY SURFACE TYPE Or, A, f�0.V t_aERK ADT ROAD RIDGE OOTNER (Specify) FACILITY TYPE Z Z-C2AA.e.s ROAD BRIDGE OTHER LENGTHS , j BUR FACE WIDTH 6...0I LENGTH (OYerell) :WIDTH (Curb to curb) 0 ZLo : 3O (2) 4.41 t 2-1HEIGHT' LENGTH' WIDTH' DIAMETER: ELIGIBLE Q INELIGIBLE (Giver RECOMMENDED WORK rbrI 1C-5 C.32 Lr . t. , Q r /.5 I ‘'‘.5 `I W Ref,(0.e.C. "k1 Zcf . X t 8'1r " f DETAILED ESTIMATE 2- ( ) ri c7 �, c' .1. J QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE: COST 60O 1 D Lii 3L C V `r 5 F \L-- wpb . GratiC ��"�ivec- �Ji jCi�., i,oco O...O ‘, aft (poi F Ii , Z,"1 2. t J SIGNATURES (Inepeeffn8 Eraineere) � i/I C/l 1,d '-ii. l` CC � �-+�, IBPRI TOTAL ESTIMATED COST ___ 2. 0 C; S3 f r o �,� r * -. t� �.,' `!,�': -- -- -- (SHD) _ _ IF SPACE IS RE C.A.'. 7 r, I`CCLARATION (2, r Cr f ronM I'R.1130 ' U.S. DEf'A.P T MENT OF COMti'[r^.E :Rev. �•eal fUfl r... Au 0. P.,nLiC N' 1 '{ INITIAL. ENGINEER INSPECTION REPORT - P.L. 875 (PPM 33.7) REGION NC,. STATE _ {-- _ DATF.'JF`INS PECTION� 44// COUNTY ! �J ' Id i 'HOTo RCF%RENCE -. , C> c3 . i ow zLOCAL i i] EMERGENCY � TEMPORARY REPLACEMENT DEBRIS GRANT 1N CLEARANCE LIEU J JURISDICTION C CO,REPAIR INSPECTION MADE BY REPRESENTING STATE OR PROJECT NO. ITEM OR REFERENCE HO. _3 L Z. f -r ,t,,. C. fL S (-{ D ` DESCRIPTION OF DAMAGE A 1,,,-..'1,,,-..y. ( '. I 1 1 ( t.43 45 k 4 `-'uk � Q � J& 3h IA..) G S eked 0 u...'' _ p v`, JI ! f2.av PT TI m.ber 3)1 vev:,l ow Loci I E w *sk rf ;, (� I [CO' f 0,..a W e.l s 4 o d r' l,. •t i 3. !% :, •... 1-) � O LOCATION //� / E 0. 641 f -f o V", ORIGINAL FACILITY 11 SURFACE TYPE A-5 yob, Pn,./,. �± i 1+0 >100 ; ROAD RIDGE 7YrHbPr OTHER ($peClly) FACILITY TYPE 1 1 • ROAD BRIDGE OTHER 1 LEN4THI LT { SURFACE WIDTH I ; 22. LENGTH (ON v.A) WIDTH (Clsb it:, curb) " LENGTH; 12.0 1 WIDTH: • l HEIGHT: / .J DIAMETE:i: S ELIGIBLE INELIGIBLE (Giv mason) RECOMMENDED WORK / I /�erltce_ t. �,b, - Drl d c.., sf �v� - 5 r-�c;� - .-. l,kia I j DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION 1 UNIT PRICE, COST a0c o 1., .] o Li/ tz. Cy !! 5F l� £I4%bk+, .5L,ir-(1ac,,i Gru✓t., Trnber- /3r, T myel- t t/aIC(R�t4'I",',,?� /, 00 1, 20 . Lto0 3,so Z) Oov, 7S, ? I GU, 5,400f I. I I + SIGNATURES I (Inspecting - ! ' �� 3 �� t1 --a IBPR3 TOTAL ESTIKATED $ L,. "') //� 7 .'� /� .,/ !' Engineer') I COST Gj ) ., \ '/'' it ,..f^...il �� ISHD) ...., 1 �.(" J ,i I __..� ....� r... .. rr •, rr� u:cOMM•7C. w..ae-PMA IF MO SPA E IBS REQUIRED SE C)MT. Or DECLARATION • i / f •...ter .FORM PR -1130 U.S. OEPAP r r. LNT OF r•l7MMENC£ ;REV. 1 -es) ---' ODAEAU or ro.tt. ac. RC*' -a3 INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (FPM ?3-J) I REGION NC.. 5 _ ' ..ATE OF INSPECTION STATE LPHOTOREFENCE COUNTY / ' - / ''� I �//�T Li EMERGENCY EMPORARY El DEBRIS D GRANT IN REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JURISDICTION t / ;,/, • F INSPECTION MADE BY REPRESENTING STATE OR PROJECT NO. ITEM OR srFt'RENC:: NO. _ jr�J DESCRIPTION OF DAMAGE ROKdUJG y,$ ..3N ,I Oct --14. , ,,r.o /tor, n ; v-. LOCATION DI,. ' `'' , r,, A, <i- Pr, ,' 5 4 2 mS s. c. 14µ1f ',. v ti..k. E I ' S I ".- E if A�rf, !x' -" 1 m� N. 4 % -? _, T° ,. F ►T L . rr, . i r 't• N Yy 't^� E G , G c�ie -1Lo .-A to ' E. Jilt; N 4 i.L m' g o c G -r t er F. '�-�rrl.: W of G c Ie to,•. — L - 4--, Co.- LL , G. 5, - L of G�. Ie+o., 14, 5 .-.4. E t�tt„<1 jy ' N oc -. Ic fo : J 5 j - N /a- W , - ,: ',''' a.., / ORIGINAL FACILITY l SURFACE TYPE' Gru �4-� I AO. Ai/J ! ROAD Q BRIDGE O OTHER (3Pecl1y) FACILITY TYPE ROAD BRIDGE OTHER LENGTH; i 2-00 LF I I $UR1 1FACE WIDTH 1 } LENGTH (OVerel) j WIDTH (Curb fO curb) 1 1 I l LENGTH; HEIGHT; WIDTH! DIAMETER: ELIGIBLE Q INELIGIBLE Mk* RECOMMENDED WORK tt vv,bn..k one At tit tr .c et c_ t w DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE CO... Z 100 36o G y 7o�s EIn^Da,,k ewf S u tr a c I In . i �) 0. s0 1,00 i I 1O O, 3Li 3, SIGNATURES (Inepectln= Engineers) t ,_—J A tom 1 _ 1 L;'i 00 Of :;: ' .r :.a \ i L.JL.�' {DPW TOTAL ESTIMATED COST $ r I LI i - . `.�' �j _r , _.• /�. MO SPAC rISj�J/EQUIRED USE REVERSE SIDE OR SEPAF F 1 4 err. �r ECLARATIOt woRm PR -1130 ,REV, 7.531 I OAT: C.F iNSP-CT1ON {i - t - PHOTO A"It ,�.:. DFPAI-.TMENT OF COMMERCE CIUIZLAil OF PURLTC ROAD$ INITIAL ENGINEER INSPECTION REPORT - F.L. 875 (PPM 23-2) !REGION NG. Cl ;STATE COLD COUNTY EMERGENCY ❑ TEMPORARY 0 DEBRIS REPLACEMENT CLEARANCE GRANT IN LIEU ,,q,, (d LOCAL JW-.IOICTION INSPECTION MADE BY REPRESENTING I. ..0Ioo5 1, P1� STATE OR PROJECT NO. ITEM OR REFERENCE HO. 2. h,C.✓-. CDH ✓I DESCRIPTION OF DAMAGE ,,NdyG Wa5&ed owf" e J I A prom:, fo e,,W4 ;L d o4 . P.. fin„ , • I ak✓+lpor Co 3. LOCATION J q , l r -{ A :, lY.M E aNd! i `/Y O� A Ii,lot'. e. 1) ' E 41.-,e& 7 — N of A.44. '1, ORIGINAL FACILITY ROAD ZBRIOGC........ SURFACE TYPE G,,.,,, de., ( ADT rj OTHER (3Pecl/y) + FACILITY TYPE C I. '" , a 1�0 %irnlD-lr a rice,, ? 1..v+c.; ROAD BRIDGE OTHER LENGTH' SURFACE WIDTH 0 V , LENGTH (Overall) ;WIOTH (Curb to sorb) .1.-4I LENGTHI WIO'T.•r H£IGHTI DIAM F.Tta: ELIGIBLE Q INELIGIBLE (Giro reeeon) 1 1 I RECOMMENDED WORK �e. ? (Ate,Qr`I d n � R� p I q c i ,. R t- 1r. J , J I, S kr{ac 1,. q — EF-we ,,,c Ike pc r- 1J cl1 DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST 1 I D 6 0 57 2-5 C- 5 C)/ SF T E - m€ .y s c- l Re. ?et. t r. �.J C=- vv Dct..r•kw.ekk ��idye 12,%Ai1de_ x qk sc .`r'T'aclvj' e I L S CIS -O G.IOo /, Qd 13 0O, 530, 35/Sb. � 2'), I i SIGNATURES (Inspecting En/ Insera) TOTAL ESTIMATED COST 1 i S J 6 I. t��//^�' ::: i f � r ..r n,r•.r nn c.rflw�ATC CLI«T USCOMM-C' C . •' 'IF MORE SPACE IS kEQUIRED USE REVE [,_CLARATIOW FonM PR -1130 ,.aEV. 7.631 n � U.S. DE_PAR'McNT C)F ::OM7.1r:p-=-c ALMEAu nr PVPLIC tics i ,ATE '� i`9'ECTION = j."HOPG F::. :,ERCNCE ,•� �+..,� 0.c&ur,Y,� EMERGENCY INITIAL ENGINEER INSPECTION REPORT - P.L. 75 (PPM 23-2) REGION NO. STATE. 7/O COUNTY TEMPORARY REPLACEMENT CD DEBRIS CLEARANCE GRANT IN LIEU LOCAL JURISDICTION Co. INSPECTiON MADE BY REPRESENTING : v.1, r,Ibbs aP a I. ♦.F STATE OR PROJECT NO. ITEM OR REFERENCE NO. ( � lY1GL 5 i'1 D DESCRIPTION CROF DAMAGE �( ,JrI' Ji �QSk e c( Ou 1 G'�.Y ��'r,1 AOT < 10O I i� 3, E ; L- , Kinbco- Co , LOCATION n-,.i E 4' /Y^il N O c N u H" j ORI INAL FACILITY SURFACE TYPE E ROAD RIDGE Q OTHER (3P•clfy) FACILITY TYPE ROAD BRIDGE OTHER -I LENGTH* I SURFACE WIDTH i 5.0 I I D I LENGTH (Overall) j WIDTH (Curb to CWb) 4 ' i zy- oIId Br) 1 LENGTH/ HEIGHT' WIDTH' DIAMETER. ...1 ELIGIBLE 0INELIGIBLE (Div* reason) RECOMMENDED WORK ke h. (A', ( ci. B rid1e Apr DacA Fs ►(5 DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST 2. 7 G j 5Th LI C c y 5F ro rr . E 146 Q IA.1^C w(Q,4 1 1-5rldie 12-`' tde k LIfS4La+.gcJ r 5 u.lt-'� oL C. t. \. G re.,, v e & I co Coic'' r 1, o o )', 3 50, 3//5 I �4 S, SIGNATURES (Ina�ectlr+J a'naln e.n.) I ) - l'T. (BPRI J''� TOTAL ESTIMATED cos' ° $ (� CJ ! V ....-• •••••••••.- n .- or nn orononTr curcT IJSCOmm- ^t IF M0RL� PACE IS,QUIRED USE R or OFCI.A'RATION Fo M;'P.-1130 rt:�ev. 7-eal DA1:. OF INSPECTION V.S. VT OF coMrACr CE IRZ:oiON NO, runLIC rtCr`o8 !STATE 17HQTC REFERENCE INITIAL ENGINEER INSPECTION RE?o:ii - P.L. 875 (PPM 23-2) I COUNTY [ 'EMERGENCY 'TEMPORARY ED DEBRIS 'GRANT IN REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JC:•:�OICTIOx INSPECTION MADE BY REPRESENTING Ft N.( 3. , !)t,t I" STATE OR PROJECT NO. a I7EM OR REFERENCE NO. 7 LOCATION %,") i n. s 0 Rock ?or -t -O,E e �D 2 Yn^ S j yv�',E oz 4Zoc kQo�. z al �'. z • FA ?r, fill S. F7(I a+ DESCRIPTION OF DAMAGE 4 fir, W tl .ke d o ± LEI ver ctiev:. a o d Br; oqe �`CL`v.a e ORIGINAL FACILITY SURFACE TYPE rove O ROAD CJ BRIDGE Q OTHER (S'peclly) FACILITY TYPE 2--LecAe5, AOT 00 ROAD BRIDGE OTHER LCCNGTHI SURFACE WIDTH / 1 8 I ELIGIBLE ❑ INELIGIBLE (Give LENGTH (Overall) I WIDTH (Curb to curb, LENGTH' WIDTH: HEIGHTI DI AME RECOMMENDED WORK v., IV". 4Ce I C I i I $ 6' >— pc.,' Dry c+�C u}�r'OA,kP:. I R��, r b r:ctie Ql.d Ire rkc e L(��-d T -A1 I , DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST a S c y -' I tw,elel,.cy gePatr. J E w,,b 5ur��c.t ti L s c,So 1.,00 Soo, Z 5S', 4D. 1 SIGNATURES (MalloyQ ` {r ' =. 4'-:4'=+ TAL ST :sD • J • f (�' � l/ j+ ••• (S H p 1 IF MOREV)PACE IS REQUIRED SE REVERSE SIDE OR SEPARATES 1t DECLARATION. FMRH PH -1130 {REV. 7•eal AVREA•� OF PVnI-IC ROA J.S. DE'ARIMFNT OF COMMER( REGION NC. I:( DATE ...F INSPECTION PHOTO REFERENCE -? . Q EMERGENCY REPAIR INITIAL ENGINEER INSPECTION REPORT • P.L. 875 (PPM 7J-7) [24.EmPORARy REPLACEMENT CLEARANCE LIEU DEBRIS GRANT IN INSPECTION MADE BY REPRESENTING aP& S 1-t r STATE OR PROJECT NO. STATE COUNTY %J. • LOCAL JURI' DICTION C.L'') ITEM OR REFERENCE NO. F LOCATION A Lc o a of F osS DESCRIPTION OF DAMAGE vs t P A pv-oac Gi wa rt W4w.a a� fo �r�dYeS u � ORIGINAL FACILITY SURFACE TYPE G v-4 ✓r ROAD CEK3RIDSE OTHER (3pee1Iy) FACILITY TYPE 2, Lee ot(.2S, 4 ROAD BRIDGE OTHER LENGTH: SURFACE WIDTH Ic LENGTH (Overall) (2/ELIGIBLE Q INELIGIBLE (Ollie mean WIDTH (Curb to curb) L£NGTHI WIOTHI HEIGHT( DIAMETER: RECOMMENDED WORK C P4Ge L.e l SI..a(t Ake K.+ Re 7( cc_ O-. a DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST J 10^ I J- / C-5 c / T' EA 5r,clie ReA Re ?At V- b. �b k�.f � G Ya Q e k 5 IA.r'4 a �1 A. Cc t i r (Q W0.lf T4>,tber- w� L S O, 5 -O 11 0 2 0 0. y 5-O, li !S , Z OO, SIGNATURES (lnepeellnQ SnQlnee:y I ( I I t / i 97 ' l.t tp 1. t 'l. ,r r •- (BPR) TOTAL ESTIMATED COST ..r�r Q / S V b S , i ; 119COMM•OC onvn•r,e.x . l / ,/,-/ ( _...2.1").. , i...., �� ; �' i _ .. (sHD) .....,.� , IF MORE SPAC S kEQUIFtED U I.) S. DEPARTMENT OF C'0M!4c::C R8G1 .G. • .:,c. •.,r UCl.lnnn I ..n I G _ / — ✓ r vnr•• .. —� 'WHEAL) OF nVn,IG its '3 iREV. 7-6D) �/ INITIAL ENGINEER INSPECTION REPORT • P.L. 875 STATE _ • . , ' DATC OF INSPECTION 7 f / _ '-''' (PPM A3-?) COUNTY y ° i '- ti PHOTO REFERENCE q-:',) a EMERGENCY CkFEMPORARYODEON'S 0 GctANT IN REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JUNISDICTION C r INSPECTION MADE BY REPRESENTING �� STATE OR PROJECT NO. ITEM OR REFERENCE NO. 7 I 2. t"i✓�Cl SHJ^i DESCRIPTION OF DAMAGE ,b r, C' ) cPrOaCIs wa:;Cc/ ��... I i:;// Was4ecI ow Y. 3• Lip" I— Co, i , LOCATION I . 2 , of 13 P. 3S dale `- :. NU (of. II g Sao wtl 1� aT II �^ i - ,5 rM,l Ni 1 - I✓ Tl'. li r, cc i (i.t (0 v.,� S"N KE o-rt ,;;,, ,.,_dG(� . ORIGINAL FACILITY SURFACE TYPE A —(_' i A$/PL.-i'- '' )- = iv.,f "f''7 I 0A0 0BRIOOE OTHER (SPeCUy) FACILITY TYPE 2. Ckµe S >100 ROAD BRIDGE OTHER :ENGTHI I SURFACE WIDTH l I r )-) �,r_ 1 I LEN OTH (Otetail) 'WIDTH (Curb to curb) I LEN 0THI WIOTH) HEIGHT) Oi \MF.FER: [171 h ELIGIBLE Q INELIGIBLE (Oise reason) kIzCOMMEND£D WORK 1.„ moo.- 1.4 • E,AA.bC' 4...tr Ii 0c��$ . „A it' ...;14,,..1. Ac e W, G,.4 ....,e , ,` DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST 9 00 1 4. a C. Y 7 E b0.�k e,Ct su r-rck.�.I, 6.• d, so I► O0 4 CO. I SIGNATURES I \ _. J f.1 •-��'? IBPRI TOTAL / 0 , ESTIMATED S 1O (Inepecfing Engineers) 1 1 )19... /. , ' ' , , 1'. .. r•onr nn C1.7CCT COST 1.:'CC UMM•LI l' 7",0.nnd IF M0REt,5PACE IS kEQUIRED USE REV SEPARATE i)ECLP,•F4ATION room 'R-ii3i•_. •.. -tea H.S. DEPARTMENT OF COKhii--tCF, REGIt%N i+G nunrAtl OF POI;LIC Rs' —`9 :"..ItTr OF INSPECTION - — ' -- 7,C.- INITIAL ENGINEER INSPECTION REPORT - P.L. 875 STATE -,-; (`' PHOTO REFERENCE (PPM 23-2) COUNTY , 0 EME t NCY REPAIR TEMPORARY C7 DEBRIS El GRANT IN REPLACEMENT CLEARANCE LIEU LOCAL JURISDICTIO,J C> INSPECTION MADE BY REPRESENTING r- E.P K STATE OR PROJECT NO. ITEM OR REFERENCE N(:. / O ` HD 2. C -' DESCRIPTION OF DAMAGE L c.... c. q` c.," c. ! '. 'c 0 VI eu(V ';-f-J u11 ovtered 3. ^\,..,.1oar Cc. Apt -0E hes +a ✓rt d...,» i LOCATION (` �G r�11 �'-tr M.ilt 5-E O'1 �t•oJ?t" :;'' � y t r of n •- r , . 1E J YS� .fit GcOC.•r' r°'' " ,^ .� 5 S . E dr. .(rjr OVt"r _ : -t„ M; 3 t tyc K ir; :7 , ., ,C,, rem', E.) J N)' t4 c'� �cOvt�, : [� s SJJ O -T Gfove�r, _ F I M/�A (o ".•A N) 1 PM E OC �•f-aHc,�gM ~ ORIGINAL FACILITY SURFACE TYPE I T .- G �v�( I OTHER peeifp) ROAD BRIDGE O FACILITY TYPE I > ,:,.� ' 2 / cA. ` -- t ` J ROAD BRIDGE OTHER L EN GTr.t �SUR RACE WIDTH 1 ji t C ' LENGTH (Oveteii) :WIDTH (Curb 10 OWb) I t LENGTH; WIDTH: HEIGHT; ELIGIBLE Q INELIGIBLE (Giro tewson) t r c RECOMMENDED WORK SiL. ' r RE CO✓`v-.A.c ' �N1p4...i�w.etti"t- . . 6ra(Je( .)tA r ;4ce, DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST 214 OO .24)4(T C y kvk batty kw\e, . s kT"c-OLG,..,, cr.k. aC 1 drCO Itno 12- 00 16if SIGNATURES f/ , �� (GPR1 G7�/�"� TOTAL ESTIMATED CAT S C.� (4 �% Engineers) Engineers) -. / / i' ' ' i �� L_. IF MOREfiSPACE IS REQUIRED USE REVERSE SIDE OR SFF'ARATE SHEET VSCOMM-CC -• " A-' ::r ( F.C::IAATION InEv. 7-65) u..a. DFPA':TMENT O- .7O'..'k;-RCF, t;'f:GI"4 ;1O. • jDATE 'JF INSPECTION - S PNOTO REFERENCE INITIAL ENGINEER INSPECTION REPORT - P.L. 873 (PPM 23-2) STATF Go ') COUNTY • ED. EMERGENCY REPAIR TEMPORARY JC DRIS 0 GRANT IN LIEU REPLACEMENT CLEARANCE LOCAL JUR.;DICTION INSPECTION MADE 9Y 1 • REPRESENTING SNI) STATE OR PROJECT NO. ITEM OR REFERENCE NC. I i DESCRIPTION OF DAMAGE CLtfvtv"f3 La. -r'. AZ. 0 IA c, -.-?e Slob d r tl� W ° �QbY�S ReNnolic :,CAT `r; ' (� o.c N 41 o— W. 1.4 cpc L W ' .C ry tANh )'AA i �l y YM w O �j' ROAD ORIGINAL FACILITY 1] BRIDGE SO t i ((3J y0 r 150 ry �I$.dEl c• 3I.&i $� �iM\ \lJ RoCkpert, -OTHER ((peclrr) SURFACE TYPE S rck ✓t`+ { FACILITY TYPE La.1<c ROAD LENGT.it 1 t j ELIGIBLE SUR FACE WIDTH ' BRIDGE LENGTH (Overall) :WIDTH (Curb to curb) INELIGIBLE (0I„• reason) �''>•• • ' OTIiER LENGTHS ,a, >^' WIDTHS HEIGHTS OIAME "ER: 3 (0 RECOMMENDED WORK o`pk -t . A- L P—I/A)Ct �jC m•F,.4S C v. ( v e r�' .. Retnlove �e1, r1 s . DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION a►t k+AP :47l G Svt,-4acIo�� D>e orris „AA „0.k 3(,1 CLdueri- UNIT PRICE cos /g 4O /00, /6 O SIGNATURES (lnepeclln& Englneore) IBPR) TOTAL ESTIMATED COST — U3Cn�"»•DC - 1F MOREyS E - E./1�Cv�REQUIRR FAO USE REVERSE DE OR SEPARATE SHEET ‘ v: CLAAATIO.N Fesa'a PR -1130 11.5. DEPAI17Vr{:T rc f:v:1*- .7rF RE',; XO:1 FAQ% DATE - i- '..-_ 1,,f) inzv. 7 -or; INITIAL ENGINEER INSPECTION ION REPORT - P.L. 875 �PPM23-2) STATE C 0. ,N:i,>..=TION` 17.. - :1 r COUNTY i PHOTO FeFERENCE ti EMERGENCY REPAIR TEMPORARY REPLACEMENT Dj DEBRIS CLEARANCE `I LOCAL JURISDICTION ! -O NI GRANT IN LIEU INSPECTION 2. 3.'ION MADE BY /:' , / REPRESENTING E -t'& STATE OR PROJECT NO. ITEM OR REFrRENCE NO. DESCRIPTION OF DAMAGE _, + 13r',C{pt /� Yro.c(. t -I l `, , .o CciI ( Re Sp/'N' W$// NG1nS J _ r ± r1C� T �J f 1 , . 'n b A 1• CO, LA l O N 1 v,,,,', 1`f 5 nn; t o -r iv. k In In , ORIGINAL FACILITY SURFACE TYPE Gra.,,,e,S AC (z(RoAO 1324:RrocE OTHER (SPeehty) D FACILITY TYPE 2 la Kt, 1 I I : ROAD BRIDGE OTHER LENGTH' ; SURFACE TOOTH I 411.,:'7, I 1� I J LENGTH (Overall) j WIDTH (Curb to curb) I O 1 �� I LENGTH' WIDTH' HEIGHT! DIAMETER: El ELIGIBLE C]INELIGIBLE (Olvereeeon) RECOMMENDED WORK {� , Re ‘)c..,.1- NGi.+.G1rA.Es Oh ilr'dges '! (t I-rng coo US 5o_c k c-, l l Y okt, tits, DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE ! COST i 7& n C.— 0, C, y, 7e. P/ W �1 l.Ja(tS twkbc...+,.kmeAt 6.,'",-4 tie/ .5.e.„-4 a,. i 2 .4.5 D. Sp /, DO 3-6 J, SgO / 2 O SIGNATURES (Inspecting Englneere) I (BPR) TOTAL ESTIMATED COST $ / 7 -- - //"} / J .. L i} �' f i :Y .r. .,�-_!" ��..— (SHO) `� - I ![`/-/�� , �� ! rr r..a-.r nn c•rnA ATr CL'CtT UICOMM•DC n 7 h -: -r 1 C F MPr ' >I S�.U-I R✓.��Ca Sct'iL— E TE OF DECLARA'IiON ,ORM rR-1130,- 1REV. 7.031 OEPA"•l'C`:l i.L_CiQN NO, - ,,— ,.,a - 1. ^r' STATE DATE.OF INSPECTLON Z ' `� INITIAL ENGINEER INSPECTION REPO::(1 - P.L. 875 COUNTY s,).+ !<, PHOTO RE r cRENCE (PPM 23-2) r Fo'EMERGCNCY CYEMPORARY O DEBRIS 1 GRANT IN REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JURISDICTION CCa , INSPECTION MADE BY REPRESENTING 1. (',l`•, ,)? PR STATE OR PROJECT NO. ITEM OR REFERENCE riO. DESCRIPTION OF DAMAGE -(O Apv- F111z T, B,-t�,<2 . W4GACC 7., ,-� 1�, i, n n ii I r H LOCATION / r ,Lj } 1 Mt II* eti. .t 2�M % % rOf MAO f' N', : Nor'�� J / Z t'il't E O'T NIA net ' U : ORI INAL FACILITY SURFACE TYPE , i A6T OTHER eC►1Y) ROAD BRIDGE Q (�p FACILITY TYPE 1> >c�I (R ., e _.L__•-_ ROAD BRIDGE OTHER LENGTH. 300 SURFACE WIDTH ' LEN OTH (Overall) j WIDTH (Ctxb do slab) I 2 ' I /�O 1 4ENCTHI WIDTH, HEIGHTI DIAMETER: ELIGIBLE In INELIGIBLE (Ohs reuon) RECOMMENDED WORK Lw.tr4 e C s1oG F 1.5 id( +I, L l vfv--� J / Rat(ac� 2 5 ,A� C3' r[d:Je L+7 c'ac:n 13., c k 4.'(I Ara , F l 1; 1.15 t?) r, DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST ,S lob 1 1O � .5 Ci/ •, -7. .twter,e,.c ..i.I.- vv\bl4 n \-". rile 5 k 4.[ i',1 (j�uvC / 4,s. 0, 5-0 J, 00 300, 2.? 0, 12.O 1 SIGNATURES I ` � J` {/-� . aN�� MAR) TOTAL ESTIMATED S D J (Inspecting 6n/Insets) J _ f=' .; COST ,r. / s -T7 Q1° P:0LAt•i'fiON J. ,:'J FORM F''N-1'. ' .. IPEV. 7.4.'I; c1=GION NC STATE DATE •:•r INsPE :TION i , - I PNOTO RCVGAENCE ii rilAL INSPECT`•'DN REPOT - P.L. '375 (PPM 23-2) E EMERGENCY REPAIR TEMPORARY u DEBRIS REPLACEMENT CLEARANCE GRANT 1N LIEU COUNTY �- i..00•`.L.?UPI.J1. (iO;I Cc INSPECTION MADE BY REPRESENTING 1:1?/` 3. 1)j).,r LOCATION )1/0t4. D t U ry.ry J 014 14 CO, STATc: OR PROJECT NO. ITEM OR REFERENCE NO. `/ DESCRIPTION or DAMAGE r c a4A0 ORIGINAL FACILITY Q BRIDGE SURFACE TYPE O OTHER ('pecllY) [FACILITY TYPE ADT GYGcv� ,2 [anc5 < <�vl ROAD BRIDGE OTIIcR I LENGTH' 2\0° ELIGIBLE iSURFACE WIDTH INELIGIBLE (Ole. r LENGTH (Overall) j WIDTH (Curb Fe curb) LENGTH: WIDTH: HEIGHT: DIAMETER: RECOMMENDED WORK Re t c e. 1' v71/4, ID Q Lk. I►C mN )14 wide DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE ' 120 0 eO EIMlt4IAA( ►►1e �- 1 S wV-�a c 1 . rck J e. OISO /.0D SIGNATURES (Inspect fr.g E,, ineera) ESTIMATED 7:-;=t • � �, COST ti! /My 4� �� ,.T! : {SUM IF MORE S ACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHUT 1W. / _ d a,r.y (BPRI TOTAL COST Is .1/42. -1 ARATION , OAM PR -113c (REV. 7.331 OF i.•. ECTION j — - /�✓/ PHOTO REF .RENCE U.S. orPA^ .i :•' A: CG:yir.- c:CF. ' RcG,r•T, i,G. - - nurr.:.!I nr PUOLIC I STATE' INITIAL ENGINEER INSPECTION REPORT - A.L. 875 (PPM 23.2) ICOUNTY I ' _• //._ . FEMERGENCY TEMPORARY El DEBRIS CLEARANCE C CRAN7 IN LIEU LOCAL JU1aSDICTIC:4 ICI INSPECTION MADE BY REPRESENTING STATE OR PROJECT NO. :ITEM OR REFENEt',.... O. I I 2. �-- //. /• -rjG/J /� O. /-/ DESCRIPTION OF DAMAGE l �r fa ,.5 r/ sn wgS/,- .. u-` pro ire. 71, 6,e, YYtt°'nSur�.: i', :G V.. • .. ' 3..J:-/�.-� L:"-;--...e/c1....7r��'Ei�., ��/ LOCATION - /A�, E r -c 6j r -r5 .'•t . -•• ORIGINAL FACILITY SURFACE TYPE 1-1 f, I- AG.I \ 1 u / (- ROAD OTHER (3pealY) 0 BRIDGE O FACILITY TYPE / ROAD BRIDGE OTHER LENGTH( I SURFACE WIDTH I I I Z I 1 LENGTH (Overall) ;WIDTH (Curb t0 curb) 1 1 L C/ , I / LENGTH( WIDTH: HEIGHT( DIAMETER: 1.--.1r-�LIGIDLEEj INELIGIBLE (Give ...arson) RECOMMENDED WORK AVvjet; r Apr.,a c;;G S 0 /,'jv+<:r,e F...' / , P oc-f,c.f- �IYr.,C1uv, cav' :oUC`, , DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST J 7--6 D G s . C Y Crhat'tIE'.. y/ ,eePCt1v' 6,n b u el k vv. k e n.-#- r J /( on / G Q�� 7 f" 0, SIGNATURES (InnepecUri Ewlneete) ( � �� }t'� (BPR? 111 t •`` t- 1 " .. TOTAL ESTIMATED S S., -- I COST �' /, . ..J a0 n.P,14 e ✓ --- t e-- -.. i I S N D I r •-..-11,...,.••,n rr nra QCOADA7C CLICCT U3Ch+iU•Or IF IF RE SPACE lS HLQUIRED l :/•: CLARATION "QriM .",3' 1130 !REV. 7.33) U.S. DCPp'^T:ACNT OF COMMF.'CE nu.lc.m or PUBLIC, HOA- • HE,10i+7:O. OI,TL OF INSPECTION l / PHOTO REFERENCE INI'IAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23-2) STATE —, COUNTY J EMERGENCY REPAIR r TEMPORARY REPLACEMENT DEBRIS CLEARANCE 0 GRANT IN LIEU LOCAL JURISDICTION f -I INSPECTION MADE ©Y 7'9/11/ J;- LC.:ATION 11 , t./ m�4 " ' , Y l `v,s ► 01- REPRESENTING C1cr'L/rT T f STATE OR PROJECT NO. ITEM OR REFERENCE ..0. DESCRIPTION OF DAMAGE LL.rtJr— ORIGINAL FACILITY 1'T ROAD {] BRIOGE OTHER Opsclly) SURFACE TYPE FACILITY TYPE ^7_ — /ctr(' [LENGTI ROAD I$URFACE WIDTH 1 0 BRIDGE LENGTH (Ovsrell) j WIDTH (Curb to curb LENGTHI • HEIGHT! OTHER WIDTHI DIAMETEr. ELIGIBLE INELIGIBLE (Giro reason) I RECOMMENDED WORK J,�77, /4-,) r.:Ltr-�AtIy ..• LL) I .j DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST <y 7 k Ate e toy 5 /.D 49 2.76- �f SIGNATURES (Inspecting Enalnssys) r 11, 7j n n V TOTAL L/� ✓ G C �� IBPRI ESTIMATED / COST' (SHO1 IFORE SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET f <-/ VSCOMM•D ' -. r. I :-: .. Or DECLARATION I FORM P*1130 ... U.,. OE'PA.C'-MI::T OF COMMERc (REV. 7-c») C1USi',AU or PUOLIC noA REGION NO. --L- i D.TE Pr' INSPECTION ;'- .. ' INITIAL ENGINEER INSPECTION REPO.1T • P.L. 875 r STATE 1 IS PHOTO RE; .rRENCE PM 23-2) i 1 COUNTY MERGENCY TEMPORARY ❑ DEBRIS 0 GRANT IN RE PAIR REPLACEMENT CLEARANCE LIEU LOCAL JUrti_.DiCTION _J G, !'/ ,-? /,./ _. INSPECTION MADE BY REPRESENTING j STATE OR PROJECT NO. ITEM OR REFERENCE NO. i 7 I t // 7, C 7�� '•D 7/ •/ DESCRIPTION OF DAMAGE, ( 'r, t�;Te- arr. FI/S u)o. e;,cn ti LOCATION ORIGINAL FACILITY SURFACE TYPE Cam, r., ,,,. ADT OTHER (speefly) r [ , ROA0 Q eRlocE FACILITY TYPE 1 ? /4. rs } ; •,_, ROAD BRIDGE 01 HER LENGTHI f SUR FACE WIDTH /So 1 '0 I LENGTH (Overall) j WIDTH (Curb to curb) 2� r i �� / } LENOTHI WIDTH' HEIGHTS DIAMETER: ELIGIBLE INELIGIBLE (Gaye reason) RECOMMENDED WORK I c F- lvl b G. ,. 4 , .,. -/ Brt c%{ C ,4.,4t., -.ht1 c .,.../../1 er,K t A'" CV-.1-• F { C:t, r-:. ,.. c ; DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST / /Z d C, C 5 C. /• 7O%>5 61,1Prr,t d, c Rep •1tr1 -14 6, Yr, b�� l Zr-i / l�r?i-2)C /7 C 7,..: ✓ Ile I/1 ✓G,/r-1. 7'4.i?.../r�y ,+�t5 / O1 C) /r U O _ (jt �ff�J L.:`,„L.:`,„ /) 6 6.7 SIGNATURES (Inspecting / t / I .. L,.. `.�,*( .J (BPR) TOTAL ESTIMATED COST S Ci Engineers) 4- y- , / (SHD) IF(M0Ftr SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET , ISroMM.ce P:,'•'. - ,. rLOCATION y..:•.. )F UF:G.-ARATIGN ` 6AT .'r ,NSoCCTION ,PHOTO REFERENCE •rORM PR -113C' (REV. 7-031 U.S. INITIAL ENGINEER INSPECTION REPORT - P .L. 075 (PPM 23-7) (-MERGENCY RE PAIR TEMPORARY ❑DEBRIS GRANT IN REPLACEMENT CLEARANCE LIEU DE"Ai,T vi OF COM7li: - RL',i or.; no. l..1 C).- Pt) 111. IC ESTATE y f k COUNTY I LOCAL JURISDICTION INSPECTION MADE BY REPRESENTING 1. s. 3 A-7/277 :,77 6-) / Z M,.a. s 4 VI w o f G a fG yo ►� Pr.� STATE OR PROJECT NO. ITEM OR REFERENCE NO. 7 C' DESCRIPTION OF DAMAGE J / redo, ,.04,heel r:'.^1 < E ORIGINAL FACILITY 0 ROAD ✓IBRIDGE © OTHER (Specify) SURFACE TYPE `7 I FACILITY TYPE Z f4ke5 , LENGTHI ROAD TSURFACE WIDTH BRIDGE LENGTH (Overall) jW(DTN (Curb to curb) 1 , 20 2� ELIGIBLE n INELIGIBLE (Okra, reason) OTHER I AOT r " LENGTH' WIDTH' HEIGHTI DIAMETER: RECOMMENDED WORK G • ' X 4-0 G NI IP c„ ,< ! -i r .l /cell? .5 -Iv - -/urc '/p dl- 5r'nr.o r'.,(.f J DETAILED ESTIMATE QUANTITY 46,5/ UNIT MATERIAL AND/OR DESCRIPTION /5,14 ry .rt re rr- UNIT PRICE 5. �, Dp COST 7 z.J SIGNATURES (Inspecting Engineers) I. , IF3PRI TOTAL ESTIMATED $ :...: I I cosT L. IF MORE SPACE IS$'EQUIRED USE REVERSE SIDE OR SEPARATE SHEET -oRM I'+2-1130 I EV. 7-091 U .5. OPPARTN:CNT OF CO . nunEAIS OF runt.' t; •.. "' R c:Du No. STATE/... [.. A•Tt CF DECLARATFON DATE -Cif INSPECTION PHOTO REFERENCE • EMERGENCY 11 RV PAIR 1NST!AL ENGtN ER INSPECTION 1-',EPWI - P.L. a75 (PPM 23-2) COUNTY LOCAL JUR;;DICTION Eli h OEI)RIS E'GNA7:T ;N r•REPLACEMENT CLEARANCE LIEU t STATE OR PROJECT NO. ITEM OP REFERENCE NO. INSPECTION MADE BY REPRESENTING 3. LOCATION /oC k n •, ti> i My /5, o{ Co try it 0 .•.. ORIGINAL FACILITY in ROAD [T fARIDCE O OTHER (3peCh7) DESCRIPTION OF DAMAGE l � it Q/ r.- r. • SURFACE TYPE -777, FACILITY TYPE 2 --C4 LENGTHe ELIGIBLE ROAD SURFACE WIDTH [LENGTH (Ovore7Q j1AfIbTH (Curb to mob) I / I C! 2� 1 Z: ❑ INELIGIBLE (Giro reason) BRIDGE . C• .� JA AQT i ) r OTHER LENGTHI WIDTH. HEICi4Y1 DIAMCY ER: RECOMME.'i6..o WORK ll,l� `s . S/,,:•c. or, '.JJe;;- COv>, ee ,1 DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION J 6.'G) U zj U r. Sr I•//E ,P'›/1.1/ 1 / • 3tnc(G w [!,e X?J.'y. .S.1.3. /'7 UNIT PRICE COST SIGNATURES (fnapecting nafneers) �t�vt `' V (BPR1 (SHOI TOTAL •0-7 , ESTIMATED . S l' COST IF MORE SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET % 41V/e- -. -. .+G . �.1. LfC' f USCOMM-D: /- 1 _r ,. 'Si. :,ECLA*RATION - 'FORM : :-:-1130---.. . 5. D7:PA.•-.TitEHT OF COMMERCE ' AREV. 7.631 .DIJOE4U OF PUn:.Ic MO • REGION r1U. ' .'SATE OF INSPECTION - -. -- 7.C- INITIAL ENGINEER INSPECTION REPC:-"7 - P.L. 875 STATE ''-' '/`' t PHOTO REFERENCE (PPM 23-2) COUNTY ✓f /-/ LOCAL JUROOICTION l _ l EMERGENCY Q TEMPORARY DEBRIS GRANT IN A t REPAIR REPLACEMENT CLEARANCE LIEU INSPECTION MADE BY REPRESENTING i. 6= r ab 5 STATE OR PROJECT NO. ITEM OR REFERENCE NO. DESCRIPTION OF DAMAGE QrrdAC C.li •tyke i v a I i . 2. I'tv\C.� 3. t", -6(v LOCATION % 5 /Z ).R. ',�✓ of 6u /Pro.,, /ORIGINAL FACILITY SURFACE TYPE r.,E ,� / AD ,t OTHER Opscliy) B ROAD re RIDGE [� j,2, FACILITY TYPE 1 ‹ I Oc.)f //i 'I ` S t ROAD BRIDGE OTHER LENGTH* SURFACE WIDTH I I 1 I LENGTH (Overall) ;WIDTH (Curb 10 curb) I 30 I /$' I LENGTH, WIDTH, HEIGHT* DIAMETER: ELIGIBLE QINELIGIBLE (Olvereason ) RECOMMENDED WORK Rc pm c.e 8r/ �j P DETAILED ESTIMATE r I QUANTITY UNIT MATERIAL. AND/OR DESCRIPTION UNIT PRICE COST .9&G s. i":":7 / 2 ' GA1,(-1r' ,Cr'ric1 j : 6.-c^ Z. /G.0 SIGNATURES (InspectingI Engineers) 1 i, 1 C_ ./^) 4 i.st^^ ESTIMATED COST • SZ i / ' - � �h /".;- — , -, f„---71, +.,. Lr. s...-,. e� - - ISHD) IF MpRE SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET { DATE ,: ALA ATION - ! F'J RM PR-I1JV 'J.D. utrrar; t.na:ry i v* •..v•,,,,. a (REV. 7 -ea) ovn LAu OF PUnLIE R! INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23-1) •••.. .•.... .•. r_�r / STATE . or ...SPZCTION _ 7 COUNTY PHOTO RE.:.:a+=NCC / EMERGLNCY D -� EMPORARY D DEBRIS GRANT IN REAR REPLACEMENT CLEARANCE LIEU LOCAL JURt:;DICTION !-- ) •� y .' / INSPECTION 1. Z. MADE BY REPRESENTING / STATE OR PROJECT NO. ITEM OR REFEREHC'i: i•;.).i ... / / �`.�- /,.'"Rou.4> DESCRIPTION OF DAMAGE Wac5 t,(• e O '� l , /// , LOCATION j/ i •;r` 'r'.. /! -• ORIGINAL FACILITY SURFACE TYPE `�: *,,, ,t :• AD'? ��OTHER (�peclly) ROADBRIDGE LYJ 0 FACILITY TYPE I sY f 1)�' 2, Lek K 0" .1 ROAD BRIDGE OTHER LENGTHS SURFACE WIDTH I 3D D JY LENGTH (OVersil) j WIDTH (Curb to Curb) I I 1 I LENGTH' �O ' WIDTHS N. ' HEIGHTS DIAMETER: f ELIGIBLE MINELIGIBLE (Olrsrssson) RECOMMENDED WORK EIMe✓ 1 evk i 5 1, o•e t=li ,rDKd, J J i ' L( C'�.e �. ' It Cr C o . it y - p to K •:., -' <-, c° n 41 .1. .< he t �c., e 6--7/ --4 , s f 'v / DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST 1:7-e) O.i. /-?-/./.5 /�//;�,/.) `--,rte,-,.,/ �+ ` `o K I' JUY ' , L S a.. o /. D O ZoO, 2 0 / ,,,,-.-f- d �IGNI TUf=S lnopoc:tn Englnserr) i e.`, J ' 1 Z (1u ' (BPRI TOTAL ESTIMAYED COST S ✓ Q % f ,'" // I ! /) f1 • Cam/ ^ fSHDI r ,nr nn nrnwnwTr_ curry USComm-OC ? l -P64 IF MORI[ SPACE IS KEQUIRED USE REV£RS: I'.ECLARATiON, FORM PR -1131, - • U.S. DEPA11'MF.::i O'r' 1.OMMEEI2r" RUnEA:J O:' P,Ji'LIC ROA ... -. - . . _ _ . INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23-2) --- iSTATE I c. NA1EJFINSPCTION COUNTY % ---1� PTO FEI ERENCE f !✓EMERGENCY C24EMPORARY REPAIR REPLACEMENT O GkAi1T IN LIEU LOCAL JURIS.)ICTION C O NB DEBRIS CLEARANCE INSPECTION MADE BY REPRESENTING G'Us e„ STATE OR PROJECT NO. 1 ITEM OR REFERENCE NO. 22-- Si.I le. DESCRIPTION OFDAMAGE '1_79 Jo)' 'J"`- Roan Asa Sl,•./ O l- I �" il lo � joo' I� SAiouioev Oki--`s.o•� -:r3.,�/;.i Gv LOCATION toq Acsv1'IIe- E.+o/4.1. , riltCA( s":'<: ORIGINAL FACILITY SURFACE TYPE a 5yak a..;r(7_/ A0T 1>I jj ..LL Belly) OTHER l�'D !• /ioAD 0 BRIDGE FACILITY TYPE 2 ) Z 4 N.,r. f r ROAD BRIDGE OTHER LENGTH‘ I SURFACE WIDTH I ' S 2-.14' I ~ I LENGTH (OVarall) 'WIDTH (Curb to curb) I I - LENGTHS WIDTH: HEIGHT' DIAMETER: LA -ELIGIBLE Q INELIGIBLE (olv) I RECOMMENDED WORK _ Re C O1A ::;:/),- yA el re, A IAJ <: ,, ,r , �' !1 .' I rt lif,` - Jr DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST / r 1.5 O./IPI e J e.,c (i)e�a1 f � G. �/� 2 Ca S :Jo 9 .1'? 0 .7:;;„--.),./.2 , 6 r. v.•, / mac. ,- 7:/. ,'� iz O SIGNATURES (lnepAcling I I / `` ,,! c f f ��• T�-" IBPR1 TOTAL ESTIMATED _ f 1j3 r�© Snglnser�) 1 I /� j� - /9 „._;/., i• f 1 COST :JSCO'.M.DC op.t•..,^'fl4 IF MORE SPACE IS REQUIRED USE TIO ,. 'C1.ARAN p•• - ,-. `:PAStTfiNT C. -%F G•),`+:.•Z..1 �e rCRPR-113O'-- U.S. DL- F.t IREV. 7 -NJ) I3UA E AV O, i`Vr'I.IC cic . ••U.,I .. ..... . -�� INSPECTION REP:Da': - P.L. L.75.• / Of ..:SPEC1'ION 1-571.7t: OF --o— — I, S INITIAL ENGINEER (PPM 23.2) COUNTY r PHOTO R� F�-RENCE I G/• E`AERGENCY•`. ' 0 TEMPORARY 2DEBRIS • aGRANT IN REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JURISDICTION C- .:> • INSPECTION MADE BY REPRESENTING •JS r r STATE OR PROJECT NO. ITEM OR REFERENCE NO. DESCRIPTION OF OAMAGE b,l-1- �/� �;) CZuK0 .va.54\<cr 17e br,S. ;D'i $o, d .i 1r`•.'/; dcr�t t' / a� c, C R.� d a 5 h -e • AOTT . 1 r ' 2. : f r C v LOCATION i � i / I/ ! i� VC L r'1 �'S ✓' . � Jo 0' • ('vrnISA .. ORIGINAL FACILITY SURFACE TYPE Gr« ,-. / OTHER (Speelly) 'i i'i :1Q:1D �BRID6E FACILITY TYPE vC% 2 t.lkH %' ROAD BRIDGE OTHER LENGTH' - I SURFACE WIDTH II /5 I LENGTH (Overall) :WIDTH (Curb to curb) I 1 2n I LENGTH! TOOTH: ; HEIGHT' I ELIGIBLE Il. INELIGIBLE (Olve reason) RECOMMENDED BORK , -Y� a�, Ct'Ar e v e o Re co„�. /8r/d.;e , DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST / v f/ aTo --- / 5- , tip . 'eod' )S C./e I':c .. 7:e'/-,,,.. - ..------y/2..--:;.//i.--- /i. - /2 'x 2d ,..,,,,,..../7„,:........,I:;,, C.57,-- ,.i''.-^." c • 0. 7-7:-./c-1," . •,'7 L.S. L. s . ;';c.i "r9.-.--.2 /� o �` !`r_i US Enaine.ro ET (- 1 / - tJ;) (// t!\ . 1!ll��-"' .'` j/1 1 IBPRI I '(:'•� ^� /,!' - i• ...�:i ....-1'. ISHD) �- TOTAL//1j COST / (/ ,/,':-- •... 4,_/// , -- :unrn „er tpc‘irmrcC Error OOP SFPARATE SHEET L'%COI s.,•)C - - - I FORM PR•''--- u.s. DE�•AP.t1ENT OF COMMC:- Rr.:ION NC. pA:.: •%: rECLARAYION tt3: (REV. 7-I3) OUR.tAU O. PUPLIC t•. ; i '. OAT: OF INSPECTION PHOTO REFERENCE EMERGENCY REPAIR INITIAL ENGINEER INSPECTION REPORT - ?.L• :7;; (PPM 13.2) STATE J 1 TEMPORARY DEBRIS n GRANT IN REPLACEMENT CLEARANCE LIEU COUNTY LOCAL JURISDICTION INSPECTION MADE BY REPRESENTIN G • ('. • -•)'.'-1 LOCATION . ?9 r f ,./'.. Z`' r.. l-- , c 7 Am-% E C, Of I.,:a 7 U STATE OR PROJECT ?I6. ITEM OR REFERENCE NO. r .C�� ORIGINAL FACILITY C ROAD O BRIDGE OTHER (PeCt1j•) ROAD DESCRIPTION OF DAMAGE , /0,;.1 r, ./ •'b / 1 ) >�O r -o.,„/ +�G.� � i t;, /i{'� ,•)� , j • l i j SURFACE TYPE r/ i"DT FACILITY TYPE z 1�.... BRIDGE LENGTH. SURFACE WIDTH LENGTH (Orer011) 7 l—ffELIGIBLE INELIGIBLE (Ohre reason WIDTH (Ciao to curb HEIGHT' `mil` t% ' OTHER LENGTH, jv WIDTH: I , DIAMETER: • RECOMMENDED WORIST) ,›�ot..}_ $Ag /, road 4Cl Re p/a cc w. -1/ » e fly •, / .,• DETAILED ESTIMATE QUA::TITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST C5 SIGN:+TURES (lnapactlnj Enalne.:re) J L.. r /'y vri r • #• �t '(i tf, i_. ' •!•&yll: • (BPR) G,mo`_ r' I l•iv •!y! •: •/,..../. . .. • �,.- ' Le -7Z— -- MHO) TOTAL ESTIMATED COST USCOMM•0, • :e•rr.6 Ilk.MORE SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET Yr /• • �: % • OF COMI•ITI2CF REGION NCI. 13VRL'.1LI OF cIj P. IC NC OA•i• 1F D•I{CLARATION I FORM R•ii3C- SFIEV. 7,131 D;,1: OF it:SPECTION ,,OTO REFERENCE INITIAL ENGINEER INSPECTION REPO:; - P.L. C75 (PPM 23-2) STATE COUNTY iIEMERGENCY CD/TEMPORARY ED DEBRIS EARANCE GRANT IN L:EU LOCAL JU;7ISDICTlON Nit ►r1Irt ... INSPECTION MADE BY REPRESENTING _. STATE. OR PROJECT NO. ITEM OR REFERENCE iit>. DESCRIPTION OF DAMAGE / •"../IOC . ., ,...G Lt.J J Jrh c.�' _•]•. ` ., ,, .r I ADT • ..J i-.:.� /J 1�..% 2. / I 3. ;. ' Ir•'> .:.i Gf C O, LOCATION ^��t F / 1::1 1� D'^ G. I • > / /:...) '�' / WI; 3. I i', -- u; e,t: ORIGINAL FACILITY SURFACE TYPE r • J^ • ../.-, • i OTHER (1P00,10 ROAD 0 BRIDGE FACILITY TYPE Z (_Q ✓-C ROAD BRIDGE OTHER LENGTHS I SURFACE WIDTH I I I 7, I LENGTH (Overall) 1MOTH (Curb to curb) I i I LENS:THt WIDTHS HEIGHT: DIAMETFAs OELIGIBLE INELIGIBLE (Give reaeon) RECOMMENDED WORK ;// /2 LLt.)r r' y DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE C057 t SIGNATURES (tm--pecllnQ Engfn•era) 1 f 7,�, J f Cr ` % /� //J ti -, ,' J IBPR► TOTAL ESTIMATED •i , $ /. •` { ' l' COST Inc nrvrocr ctnr AD eroAuATF CidFFT Cr$COMi.•• C ,.P..., IF;A({0R F? 1ySfttQUI�t£� L DECLARATION I FORD PR-i13v� .• iREV. 7.66) DATE OF INSPECTION J i PHOTO REFERENCE f 1 U.S. E:EPr'.?:"1.(-NT OF (.'�O.'AMr. ,:. • R GIOt: NO. [RURe.AU 4C' ri:iPLIG R< INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23-2) STATE • COUNTY "�EIAERGENGY El -TEMPORARY DDEI3RIS EaDRANT IN �JREPAIR REPLACEMENT CLEARANCE LIEU LOCAL JURISDICTICt. INSPECTION MADE BY REPRESENTING L, 2. ��RC 3. LOCATION f G l f � X j A. 1 : . I .'raCV•.. / STATE OR PROJECT NO. ITEM OR REFERENCE 1.0. 2_r ORIGINAL FACILITY 7TROADBRIDGE r' OTHER (Specify) DESCRIPTION CF DAMAGE SURFACE TYPE FACILITY TYPE d-r.. •' - 2 — ROAD LENGTH, ISURFACE WIDTH BRIDGE LEN GTH (Overall) i WIDTH (Ct9t e0 Curb) - " + OTHER LENGTH) WIDTH1 HEIGHT) DtAMFTt:,'.. c�iCIDLE n INELIGIBLE (Olva reason) RECOMMENDED WORK • f .. QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST /1O O / •_�'• �1t,�; ✓Ylif" r ch7 1 e ell � Pe - s A C.� ��e,'f`V $ tlr � 1,:: L < o 6 y I 70o / ,/.7 SIGNATURES (Inspecting Engineers) I I I u.,/.:....,• } r • t'' ~a (BPR)‘/?..„ TOTAL ESTIMATED COST �. f , $ )''/ `- %G /•f ../ I - ) ( / ) r'> ... ,,,,—e........ f^ 1 ,. /, • �� "' /• ' li��? r �.• .ti.i, % (SHDI r L... !F �{jARESPAC �C/, /JE IS KEQUIRE 63 / d - L p,i•: L . - L�CLARCITION . c.' — / ,... ___ rATZ: OF i.,•sPECTIONJ— PHOTO REFERENCE FOAM C'(<,1:2d�"- iREV. U.S. DEPAHT7a :N ( .�.._ 7;{ C,ION NO. BUT LA.'; P.Jr'L;,. (o INITIAL ENGINEER INSPECTION REPORT - '.L. 875 (PPM 23-2) L_ EM.-i"G NCY REPAIR TEMPORARY L DEBRIS REPLACEMENT CLEARANCE GRANT IN LIEU STATE COUNTY • J r ! LOCAL JURISDICTION ' INSPECTION MADE BY REPRESENTING 1. 1 711 C ( ' LOCATION STATE OR PROJECT NO. ITEM OR REFERENCE NO. DESCRIPTION OF DAMAGE ORIGINAL FACILITY 0 BRIDGE ROAD 040TH ER ($pecilr) SURFACE TYPE �, • A7 FACILITY TYPE BRIDGE -La. LENGTH' I rZ EkG16LE SUR FACE WIDTH LENGTH (Overall) j wIbTH (Curb So curb) (� INELIGIBLE (Ogre►:fowl) CTNER LENGTH' LID WIDTH; HEIG,HTi RECOMi, ENDED WORK ze'�s'� r' t..‘1 G G `C; 0(b.t ,..'t•:. r DETAILED ESTIMATE QUANTITY 90a UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST "14 /Do1 D, s.D SIGNATURESF'� t L^" �, r • (inspecting - - ' (8f`R) Engineers') y /, i' IF 7E R OIRED-USE REVERSE SIDE OR SEPARATE SHEET ev"I.44 iglu%yam TOTAL ESTIMATED S COST ' 9f. OMwt•r., -r. - Os7;); ;;LARATION FO:sM'ri-;13:+�� '(REV. 7.05) Cr."—.,• `q.' ...AN *:.,. STATE ;'SPECTION PH07G R'�'r:=riFNCE INITIAL ENGINEER INSPECTION i,2?O'[ - P.L. 875 (PPM 23-2) *00 EM.,SGENCY c7EMPORARY DEBRIS Q GRANT IN REPAIR REPLACEMENT CLEARANCE LIEU COUNTY rASPECTION MADE BY REPRESENTING 1. )' 3. r` ✓ / LOCATION /A) J 4.1,4A mil Culler STATE OR PROJECT NO. LOCAL jUF,SOICTIO,: ITEM OA REFERENCE }:G. DESCRIPTION OF DAMAGE .7) 6�.r_' _ .- r •.�,;,, ' � - .... .� .;! 7 ' L C /' .i - l C_L ORIGINAL FACILITY -OAD dBRIDGE Q OTHER (Speclll•) SURFACE TYPE FACILITY TYPE= `.� c. ROAD BRIDGE • LENGT'HI 1 SUR FACE WIDTH I / ,^r LENGTH (Overall) :WIDTH (Curb to curb) /00 APT OTHER LENGTHS WIDTHS HEIGHTS DIAME ,'ER: ELIGIBLE O INELIGIBLE (01re'cocoon) RECOMMENDED WORK f-' .+ /p .r 1-eID/4,-e F,'// DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE CS .GS Soo, Coot) /fie� 4 rl r` / rr'cl Ret (f ( J • b4 k er' '- 5 1, 0,50 /, OO COS 2 /6,0O, SIGNATURES (Inspecting Lndinsete) / (B PR) -.5 TOTAL ESTIMATED $ '9 /0 ;n, COST ":"7 i IF MORE —SPA E 1 F�EQ/U,RED ((ISE REV •RRSE SIDE OR SEPARATE SHEET �)" V -�� U=COMM-O f. a; -"• • r;LARAT1QN .-'.. M 'I: •.•dam - r„� -,RBV ' -.Jar •.PECTION •HOTO REFERENCE •.S. OF. PA: ' •c0 -r r3tfr.i ,� RUGL;c k'. :NMAL, ENG:N_ER :NSP.i(TIOP! REPORI - P.L. 875 (PPM 23.2) >'F.GiCif! r, STATE f_ . COUNTY I ❑ F;LiIGERCY ErrEMPORARY 0 DEBRIS ❑ GRANT ;N REPA;{.4 REPLACEMENT CLEARANCE LIEU LOCAL JUR SOICTION INSF:.C.:- : !MADE BY REPRESENTING LOC, :-. J ?-7 E. e //cicIso„ STATE OR PROJECT NO. ITEM OR REFERENCE••••:":' DESCRIPTION OF DAMAGE /✓A oa e4,..5. '10 Brrr/,ic+ < .•Ilt?u'i,rIF• - Giy.> 'lc' wa34"d, °K7r 77,• Le, 4 r . ORIGINAL FACILITY deRi0GE 0 OTHER (Spscllr) SURFACE TYPE FACILITY TYPE ROAD BRIDGE LENGTHS SUR FACE WIDTH I 2q t LENGTH (Owtwll) /� 1 WIDTH (Curb to curb) 2 LENGTHS HEIGHTS 0INELIGIBLE (Oleo meows) WORK RO 411- 13r1 dye �ekif, WA f(:; rI!Is /..,,..�r.✓r s DETAILED ESTIMATE UNIT ✓t rp ri ;;:aN.+TI. . •:k epc, L..... i ••,,I;P.. '.f.;,, 1 RepaIC .4J11 MATERIAL AND/OR DESCRIPTION Bred let 71cttL r #1"YY, 6.7 I( /fmi e i 17 , i.�✓ . 1,7 L e& UNIT PRICE COST >; ,L. 5. /eDe2 6-0 /•DO (BPR) TOTAL ESTIMATED COST s ie �'.. (SRO) ,F tS REQUIRED USE REVERSE S.DE OR SEPARATE SHEET U SC OMM-C .. •%.RATION • •FORM:1R-1130� (REV. )-6151 S. DEP,.. - GF 'OMMERCE REGION NO. CIVIC••• rsr Punt -IC RO 5 :T ION .a ONCE BY I 1 ' / _ -4? I z.!-:.2, • Li/ • INITIAL ENGINEER INSPECTION REPORT - P.I.. 875 (PPM 93.1) TEMPORARY REPLACEMENT CLEARANCE LIEU p DEBRIS p GRANT IN REPRESENTING . 22 O,/ • LO,CATi::?. 41 ,'di . -.. YY-1A N Y of " /-/4i e/ af4/ STATE OR PROJECT NO. STATE 1 COUNTY LOCAL JURISOICT;ON ••��f ITEM OR FIE=ERENC:l 40. 30 DESCRIPTION OF DAMAGE I 7I 5-00 ad} cO' Lf Root twl4.-4.A�•. .3��t 1 b0„ CLAIverr Moie.c f;o.i pre---.•. to� 47/py\ • B c",40.1-,/ one 3 0 "/lgc•ia /e.4 : . il >t 3 : , ':. • ORIGINAL FACILITY Q BRIDGE OTHER ((peclir) SURFACE TYPE FACILITY TYPE ROAD BRIDGE .•'. ••4ER A✓'i .. THI) 1 -) .- 1SURFACE WIDTH . I B LENGTH (Overelt) j WIDTH (Cur, fo curb) 1 pINELIGIBLE (Give reason 1 LENCTHI TOOTH: HEIGHTt OIAME TE►,: • • REC.C.0t.-> :. OE0 'WORK /t)L place s4/v,-1,, _,' Cufve,fr. c�.' 7 - t (-4cfi' DETAILED ESTIMATE • .: JANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COSY Cs Cy -5-14 le4 ac Cu.luerf (,O , c " C4/4/ et) I 2. /-4 . 11:9 { SIGNATUF.ES (Estop:.. HnsMlewre) -1„e, Lo (BPR) TOTAL } ESTIMATED $ ' COST 1 v (SHO) IF MOR PACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET U SC OMM•C F .A:iAT'ION ' • -IREN. 1-0:31 U.S. DEPART+Y«:T OF COMMC.RCE SUR EAU Or PU'-'LIC no REGION NO. STATE fr•-'c6:TtON :'riG':O REFERENCE ENGINEER 1NSPECT14N REPORT - P.L. 375 (PPM 23-2) COUNTY rMrhG,'NCY f TEMPORARY REPLACEMENT CL►.ARMNCE LIEU .4AOE BY REPRESENTING • i ROAD D DEBRIS D GRANT IN STATE OR PROJECT NO. LOCAL JURi'ii)I::TION 7'i EM OR REF ERENOE r?•:•. 3/ %% .QESCRIPTIO`N OF DAMAGE f f C ). L :.0 3 7 fir; �G'C %-j 7/.S + Last ,,`de aLt„4t c1>.( C ...1.'.>r?T' C of- Hi.rdra fr 2- M; :3 , o:. 4 Lk_..1.„ (O/Vf.ved LthsLed t 34'' e w T ORIGINAL FACILITY CB BRIDGE a OTHER (Specify) SURFACE TYPE FACILITY TYPE 1 6. -rove `S o ROAD BRIDGE SURFACE WIDTH 1S LENGTH (Overall) ELIGIBLL Q INELIGIBLE (Oleo meal) 20 WIDTH (Cutts to coat) OTHER A 0 < 100 LENGTH, WIDTH HEIGHTS DI AMF_T-- RECOMMENDED WORK Ey.", /Z t',, / Z ' ro f' Rep /. 5cAr#rIr , .. c. Co":.'. r »IGt•r ( �, ti t�Ib�t�q� w 4 ! . / a!Ac36" Clot t=' DETAILED ESTIMATE UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE G5 G fr' . c,v. 45-1/ / eeortS 1 , /411/w71. Belay Sa(ic2ed 36. "Gm Px3i eSai Si(r:ATURi,.. (In.. ..cttna Ent? .ere; 1 TOTAL ESTIMATED I $ COST / C /5O (BPR) MHO) IF MORE SPAC REQUIRED USE REVERSE SIDE OR SEPARATE SHEET U ICOMM.C. LAATION 7 w• r4M :''R-1'130.^. iAEV. 7.O:r) Q "PAF7^- mEn: REbUN K:,. nurser' 'i. au,•t.�c r. ': A aSPECTION . : OTI Rti1'cRi:NCE RC Eri TEMPORARY OEBRIS GRANT 1N REPLACEMENT CLEARANCE LIEU INITIAL ENGINEER INS?..CTI0N REPORT - P.L. 875 (PPM 23-2) LS:ATE COUNTY ,/A./ INSPE;;;ION w.:OE BY REPRESENTING •' •, LOCATION 3 rn S E ••-' CO/v/-22 k.' L r f u �Sa rt STATE OR PROJECT NO. LOCAL JUR ::OICTIO►+ • "/.." ITEM OR Rr LitE)(CE .s .. DESCRIPTION OF DAMAGE ROAD ORIGINAL FACILITY BRIDGE G OTHER 0100110 y,r r COwt e le 1� Wa :StLu SURFACE TYPE Cl�( - FACILITY TYPE O .. -wa-y OTHER ROAD BRIDGE SURFACE WIDTH LENGTH (Owfa11) jMIbTH (Curb to curb) 20 ELIGIBLE Q INELIGIBLE (Gay* r.*.an) -0 LENGTHS WIDTH' ; HEIGHT: DIAMETER: v;c,JOED WORK cel �..c-� by:, die UNIT PRICE DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION Betel e — /2: w,(4. / b e? 7/ S,GP. ATur-:5 pectin; ara� 9'J..P4 (BPR) %A -751:1.T -r- ISH01 IF MORE $PIACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET • TOTAL ESTIkwTED COST r COST / 440 tI �1COMM-O<, .. �ARATI0N FORM , • 1.5..7'PAnI:•i:PIT C^ r'a7MMEw'F (REV. AF. GICJ . YG. -• EV. •Oa) or PV'•Lic aOAa" STATE •7.CTION• INITIAL ENGINEER .NSPEC ION REPORT - P•L. 875 (PPM 23-2) COUNTY TEMPORARY 'i;_ P,,;P• REPLACEMENT DEBRIS D OI-ANT IN CLEARANCE LIEU IN EC:"rOSi IiALIE BY REPRESENTING ' • /---- -,-/,- • ff ('T. D,1 r ` } /7:, L ,,� / Coin LOCATION �+ s- YY, i E i^ .,f ri..� . , a j l (Ai 0,N (^ D 1 IN -4 7 rr� S 0C I ►os peci �Q t !, V k '/ S 04 1-f k 4 -.or) ROAD _.FNGYr ELIC BLE ORIGINAL FACILITY STATE OR PROJECT NO. • LOCAL 4URISt)IC'ION i •_r ITEM OR HE. :RENCE NO. 33 DESCRIPTION OF DAMAGE /It) /^rjl/ (7:3roreCi, re,,S (.c) •.J 4e c . ':1-; /?o4 o wtr S /r•cr >�. © /aa r wa..SAr < SURFACE TYPE rT, uP Q BRIDGE Q OTHER (3peCllr) FACILITY TYPE `Crue_s ROAD ioo SURFACE WIDTH BRIDGE LENGTH (Otifoll) II WIDTH (Curb /o curb) ❑ INELIGIBLE (Olro t•••ort N ; r••: 1. "i . ' OTHER LENGTH: WIDTHS HEIGHTS OIAMETEr-t. RECOMMEnitiE0W.:AK ` c ,#‘�/, 5_,„4.4k me 4./..s t kmer-Ls S1• re sz.4r 'fn Cc.' , DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE CG -T SIGNATUi:r (Inep•ci,, ,. Ena,nb c e.•, !I+1 leo k✓h e n �, 5 4r4C 4 1. o, s IBPRI TOTAL ESTIMATED COST IF MOREVSPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET LJSCOMM•PC _... . _._. .. ARATION ;FORM �R-113O IR£V. 7.6P) S. Dr_PP•• /ENT OF COMMERCE%-r.':;ION NO. AUf: .-All ROD C I iq. Aft' _r .:, PECTlON 7HO:O REFERENCE INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23-2) STATE COUNTY 71 EMERGENCY CB/TEMPORARY DEBRIS GRANT 1N RiPA:H REPLACEMENT CLEARANCE LIEU NSPECTI.3N MADE BY REPRESENTING 1 °.. / / I -O .•.TION 50uT .4 !• cii i w o '{ /-/k • STATE OR PROJECT NO. LOCAL JURISDICTION ITEM OR REFERENCE NO. DESCRIPTION OF DAMAGE `'QSA Out, ORIGINAL FACILITY LZ-FI O BRIDGE CJ OTHER Opacity) SURFACE TYPE FACILITY TYPE 7,—[ahe S ROAD BRIDGE OTHER LeNGTH, rl r ± SUR FACE WIDTH /6 LENGTH (Overall) Q INELIGIBLE (Olva reason) e r1 G / 'WIDTH (Curb to curb) LENGTH' WIDTH; MEIGHTl DIAMETER: tiC 'O WORK /1)C.644: / 0/ ,- d , DETAILED ESTIMATE UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE I .,GSA' SIGMA"?;RzS (lnepec' i..i Engineer:, c... ?oaf ere?�.�17��y��r.� S«c/2 C1 /- f7 67 A t.•. , IBPR) (/!'� �u",�p'? ^•..�� 1r ` -�►^met IPMOREtPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET / D O ISHO) so TOTAL ESTIMATED ' S COST G ✓� t USCOMM-OC v^an•'"'•. '.;L,'RATION P�irtsn•Pli-51=G .REV. 1-fi9i • 0.5. 0EPAPMCN.T OF CMME c RGGIOri :. nun -Au r^ 'E CT ION i,.FEPENCE INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23.1) STATE • COUNTY L__ Ej EMERGENCY I .E PAIR EZITEMPORARY DEBRIS Q GRANT IN REPLACEMENT CLEARANCE LIEU LOCAL JUT+;:;DICTI0N ,. PECTION MADE BY REPRESENTING • ,lQUr772J +i� AT?ON 1 VI Of F4 L C fo,A• STATE OR PROJECT NO. ITEM OR RLFERENCZ I:O. DESCRIPTION OF DAMAGE ,paf�1 CeNroue(s I ! ORIGINAL FACILITY Cyr ROA.:= Q BRIDGE 0 OTHER (S`pectly) SURFACE TYPE FACILITY TYPE Aspk 0- ' Cl/r, l J fr-f Aci �ra�'P'K'• ROAD SURFACE WIDTH r r , 1`d BRIDGE LEN GTH (Overall) ;WIDTH (Curb to curb) 7-4,/ 1 I I] INELIGIBLE (Glee reeeon) Cba 1Ae/ o-' P/41/tr i� , ,':';:%:;OtMMENDED WORK I ,.?4�, 1/ f� // µ„ 7� CoA e S C Gy/A v r OTHER LENGTH. I'rIOTH: I -•, \ I / HEIGHT. DIAMETER: DETAILED ESTIMATE QUANTITY UNIT SIGN-YURES (ins pec t.n/ meets) MATERIAL AND/OR DESCRIPTION / 4-J( (' r • (SHE)) 1! •. ;Pi 1 C` IF y.iRE SPACE IS REQUIRED US REV RSE SIDE OR SEPARATE SHEET (BPR1 UNIT PRICE TOTAL ESTIMATED COST �), S F... USCOMM.:.• - °n -ARATIOI1 . FORM PR -1130 II' EV. 1•,191 .S. DEPART` F.NT OF CO$+M =BCE 1 REGION NO. BUR F.0.1.; OF PUBLIC Jh •.•.... In • .CTION F•nO r O REF. HENCE 41_x-, --.-.ri _ TEMPORARY Q DEBRIS OEM�`�: :ACT CLEARANCE FE ?A��. REPLACEMENT REPRESENTING INSPE CirtON MADE BY • ,i '1/ LOCAT+ON y$4 ROAD [ BRIDGE INITIAL ENGINEER INSPECTION REPORT - P.l.. 875 (PPM 23-2) GRANT IN LIEU �., i i h/ pc F.rTLupfor, STATE OR PROJECT NO. STATE /- -..ti COUNTY LOCAL JURISDICTION COG/1 r ITEM OR REFEREN E NO. 3 E DESCRIPTION OF DAMAGE X 031- 3 S' T yo, tiw,� tti — s K n w ar c / i r.!<.1 re. ili tt . e I yO ORIGINAL FACILITY SURFACE TYPE G ru •C i QOTHER (Sp.CIIY) FACILITY TYPE tatiPS K. ROAD LENGTH$ L EL GIBLE ISURFACE WIDTH BRIDGE LENGTH (Owrafl) WIDTH (Curb I. curb) �] INELIGIBLE (Orr, reason) /40 RECOMMdNOED WORK SIGNATURES (Inepecling Engineers) I � V JCeColti„-rra .3' c/se 5a ..s , /8' W/ale DETAILED ESTIMATE LENOTHI O"NER WIDTHS HEIGHT, DI AME'T r: UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE .r /g -'X /�o -r, 4 71 IBPRI ISNDI TOTAL ESTIMATED COST CO'.T IF MORE •PAC R"QUIRED USE REVERSE SIDE OR SEPARATE SHEET USC OMM•DC ;i.•. T•. �, :,ECLARATIQN U.S. DEPAP'MENT OF coMMERCC RUf1C'/.1r or PUntic REGION NO. LE .GT11I lc— i I -OAT • OF ,NSPI TION__. • PHOTO REFERENCE FORM PR-1130.- IR MEV. 7-ee) INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 27.2) 9 STATE COUNTY fl CMERGENCY REPAIR INSPECTION MADE BY REPRESENTING / TEMPORARY DEBRIS GRANT IN REPLACEMENT CLEARANCE LIEU 2. -1n/d CnU� 3-�_ LoeAT:oN 717 ) M: u y� r y�, NI of PIatf'ev; li e, STATE OR PROJECT NO. LOCAL JUn.SDICTION ITEM OR REFERENCE NO. J7 DESCRIPTION OF DAMAGE r. br/s /.'+ 4A4. eI t-'V'.Y-oakdaproo!:IP, 5O.A f Jl a u MP"' 4t4j e y pn S At. 3ONC. of 17 s.>4r.s4t 20 I e4ta,Adef 5rid'e i(rr,Oce. 0 IGINAL FACILITY BRIDGE OTHER (SpecUUY) SURFACE TYPE FACILITY TYPE 6'1"44 VA /o) ROAD BRIDGE SURFACE WIDTH LENGTH (Oretelt) ;WIDTH (Cu* to carob) 3410 EL JIBLt El INELIGIBLE (.Give reaeen) /3/4/te lC, OTHER ADT 00 LENGTH, WIDTH, HEIGHT, DIAMETER: RECOMMENDED WORK Re.N+o✓a (. / ev:la ✓e OA d .S c /du`c, Gou.St /le.) arr (lb e .^ f 5'/rHe-7 care Y'e..net QUANTITY UNIT DETAILED ESTIMATE MATERIAL AND/OR DESCRIPTION UNIT PRICE COST Cs cS J4 r .ebrrs I c/eerra.n C Ro •ed) COb1sk e_f /Sl •de 574 aciii re SIGNATURES (Inepectln/ E,i Ineere) i_ �.S (RPM (SHDI _5-O O TOTAL ESTIMATED 1. 27 �,'', COST ✓ IJSCOMM•Dr: IF MORE SPA c IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET CA I r.. .. .CLARATIOI4 - , �7 r - r u 1-ORM PR -1130 ..S. OF"AR`. LNT OF COMMF.'RC.v MR EV. 7-63 RF. AUAU a1- PUt'L:c PRO/ ' i:EGION NC,. Q / OA.;: - -- ::•,> PLZCTION -.5 INITIAL ENGINEER INSPECTION REPORT - P.L. 875 STATE C r^-/"/- ' ' , •' PHOTO nv:.=i:RENCE (PPM 23-2) COUNTY /.J• ' .-' //•-•"// EMi.+:C'cNCY TEMPORARY ✓ DE9RIS REPAY. REPLACEMENT CLEARANCE CRAHT IN LIEU LOCAL JURISDICTION .1 INSPECTION MADE BY REPRESENTING ,. -'/ ef .V2 41q.,� /er STATE OR PROJECT NO. 1 ITEM OR REFERENO£ NO. 3' _.- 2. -/A-2r,1 ....U. 6/9. !7`, DESCRIPTION OF DAMAGE ph,/,,,I,;„ Df rke/ure 1'rij /ood, �/f ��/n�kF v%9'% 3 n/9�r's , L C A T I ON r .•. j,,- ; � �, o� /qrt,�� l�Ive� a'� /v14s7�Prs r / ,. hi bf 44 gers _Y'Ll{!0n b oa /` d' wa.UUrco/ (9c/f . Los/ < c/,w Gee 21 '' x-jZ' ',./,,P./ (A.kd redo c n It f' v ORIGINAL FACILITY SURFACE TYPE 2L. i SOT OTHER (Specir) �j Of.D E3 BRIDGE FACILITY TYPE Z. —tom({ rigs !S E <100 ROAD BRIDGE OTHER lc.i.--Nr i, ' 1 SURFACE WIDTH t AA i ' I 1? /2:_....)/2:_....)00 , LENGTH (OVarall) WIDTH (Curb to curb) 1 LENGTHt WIDTH= j HEIGHT, DIAMETER: i--ET1GIDLE O INELIGIBLE (Ol.a ♦aaaon) I•- , RECOMMENL' ED WORK /R 40,l.ffr. e 1'a t eiw a cz -,4 c.c., /✓t r is DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST / 0000 % ! 0 4,1 GS Cy %_ 4. /- // / / � {�ctC clr ...Deri,S Y� PrbAPc�/pr, p1 �i/ / e. ..D l rp �0tdctkc PCr/(F«t ≤' vV / S rAa c'' , 4 Z t adr./c i f / / , f/I L //, ! '1, - L ra/ S e.S`o / .00 .SDO, ypoO. 7/0 le, 00 r ---- tI ) 2- . SIGNATURES I (Inepea:lnp ( �fl�.‘ / ' . , -./. , • t.. -.Z dtr ! (BPR) TOTAL ESTIMATED COST11:2 f �? - — — . — j Engineurai) I _ f I _// r•/ L:'jr_„....t.....,...-- _--, . ISHD) j IF'fVIORE SPACVS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET U7C OMNI* C Ao•,n•Pn4 U.S. OEPAPTM;.qT OF COMMrNC, LEGION AMC. rue.- -,.,1 r,r PUnuC R •--OS �CLIRATION i FOR) *'R -:x2,0 JS PE CT ION �e'YG .1LFERENCE INITIAL ENGINEER INSPECTION REPc;?T - P.L.. 875 (PPM 27-2) STATE • COUNTY u EMERGENCY REPAIR . INSPECTION MADE BY dTEMPORARY QDEBRIS D GRANT IN REPLACEMENT CLEARANCE LIEU •Z.,�, 2.e" lots LOCATION! yZ %y Mk REPRESENTING STATE OR PROJECT NO. LOCAL JURISDICTION e? /y ITEM OR REFERENCE,,/.:0. 39 DESCRIPTION OF DAMAGE p / �. /`"0 Gt)aL/Co c� c /r o.,t o.oiiv., vJ/1<. Qd(1.1•pdIQfRI C -U;-.:, .r ;.•J.t;rci, o J VJ n AV -..Ivti TH. ORIGINAL FACILITY O BRIDGE OOTHER (Specify) SURFACE TYPE FACILITY TYPE rR vp 2. - L.avte r ROAD BRIDGE OTHER .! r LIGIBL£ SUR FACE WIDTH LENGTH (Orerell) 1 WIDTH (Curb 10 curb) ILENOTHe 1 1 HEIGHTS AOT p1O0 WIDTH; OIAM-T:i.�. C3 INELIGIBLE (Dive reason) P1s.4fe re ;If CAVAV\V% i(1ver4ed by 4 dyk.:, was/c.,' ran.:{, RECOMME O.ED WORK ':ai%lfr<k....pit. 4 h.. -ski, GCS' DETAILED ESTIMATE C.40ANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICI COST 7 — GS E � a K kvne Gr.(./E.( Sari`^.!/✓ ChR'te. 1 C/eggranCer 0, s0 70c• �1 0O 6, 0, 5 57D .'3NATURES (;nepec11ng Engineers) IBPRI , 1F MO £ SPACE I REQUUIIREDDUUSEREVERSE SIDE OR SEPARATE SHEET V TOTAL ESTIMATED COST USCOM.. 4 . aAATiON • • ' ("Am FR -1130 IR E V . 7-O3I airCRENCE I �r E.)t.R;..ENCY S.. DEP' rDEP, r Z'+ENT OF COMMFr;,—i ' RLC,ION NO. AUI-I- .'J or VUnLIC RO INITIAL ENGINEER INSPECTION REPORT' • P.L. 875 (PPM 23.2) TEMPORARY CE(D/EBRIS REPLACEMENT CLEARANCE STATE 1 .' COUNTY o GRANT IN LIEU INSPC Ti:,rl MADE BY 1. REPRESENTING r,i r_-. . Cs. oo.N, STATE OR PROJECT NO. LOCAL JURISDICTION -••• ITEM ITEM OR REFERENCE NO. Lt 0 wi.ATION ,� Mcf S -_/r L L -v of DESCRIPTION OF DAMAGE Doc. d waskIad D,e r eA f. ro fj r aka ( vO ver 1.!/ r , t, fore Drlerg +76Od • (eaI/+NG dc>c.S4 rof-t, >jo: `ROAD ORIGINAL FACILITY C RIDOE O OTHER ((peclly) SURFACE TYPE FACILITY TYPE vc; rr, ROAD BRIDGE O .-HER LENGTHS ELiGIDLE SURFACE WIDTH / 2( LENGTH (Overall) El INELIGIBLE (Give matron 44/0' 'WIDTH (Cirb le sorb) LENOTHI WIDTHS HEIOHTt DIAMETER: RECOMMENDED WORK /7 Or/0/ C cfialr p el/ea.-4.'1(e (Shiver els"'"/.Jr> DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST C L. SIONATURCS (Inspecting Engineete) br /4 lcar4:ate J7ebr;s '' C 41 bar' k n'r,r Grupe/ /Reporr er, ' , /4, t,.:1 L' • rl y4 f/00 d/ /74440; / (7e) (BPR) (SHDI TOTAL ESTIMATED COST IF E SPACV5 REQUIRED USE REVERSE SIDE OR SEPARATE SHEET USCOMM-DC p:.'n - - 1.•Ct. Ar.ATION �DA- .E — .si,ECTION ' : " '- r FOAM i'R-1130 --- J.S. DEPART., i.NT OF C.]MM.-Fr,, JREV, 1411)t3URF.':'J OF rUnt.IG FiO'- INI i:AL ENGINEER INSPECTION REPORT - Pl.. 875 O (PPM 23.2) .v,..., ,ry ..v. , . sTATE ,!•,/,--',-.. /- r �.17.• COUNTY PNOTOiEFERENCE a EMERGENCY Re: PAIR EffEMPORARY 0 DEBRIS 0 GRANT .14 REPLACEMENT CLEARANCE LIEU LOCAL JURI.OICTIOf4 f (_:'7;''/y7e INSPECTION MADE BY REPRESENTING Jam, J �'I '� • STATE OR PROJECT NO. ITEM OR REI'ERE#CE NO. / DESCRIPTION OF DAMAGE. )roctc 6//s was/, d pp ,..., .-1 . /t'�:,; us a, tir'o� c., AOT 1. - --/7 CIS (9, r.i 3. // O fr..-.45- 74- Cele./ ,,-;. ?/:"..e/ LOTION `Ai %/o,st CC4�C f V o 1I v 4 E / it/c• Lie///, ORIGINAL FACILITY SURFACE TYPE G,/ rog ISEIROAD OTHER ($Pscllr) El/BRIDGE 0 FACILITY TYPE 2. „r f q nto S (�• ` (< i �� 1 1 ROAD BRIDGE OTHER I,ENC i. . '- (i��. - SURFACE WIDTH / 7 LENGTH (Overall) jwlbTH (Curb to curb) I 1 2 /' � I LENGTH' HEIGHT: wIDTHI DIAMETER: E1 ELIGIBLE El INELIGIBLE (OIVG Towson) / pgr'R //e/ 7� rr✓�9't�.e.. C2�ta��w�+'Y L ; //e /I•` J L r . RECOMMENDED WO 4) o t� k Iii// e - 46e.;//c// DETAILED ESTIMATE QUANTITY Z�J UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST GS. y. %eft br;d� 21 1 �S /o0 0. ✓ d //� SVONATUNES (fns p. c On,. End inset.) IBPR) Y'1 � 7L `ter WWI Fj ORE SPACpt REQUIRED USE REVERSE SIDE OR SEPARATE SHEET TOTAL ESTIMATED ' $ 2 COST U5COMM-OC o-�• • "nI"CL-ARATION FORM PR -1130 TREY. T•DDI -y U.S. DEPARTTAINT OF CO>+IMFRO : REGION NO DURFAI) •1F runtl; NUAp. •. INSPCCTION _ 7- •. - INITIAL ENGINEER INSPECTION REPORT • P.L. 875 ' STATE e,/- .-7.,---- %—, ?HOTO REFERENCE COUNTY Y,, / Z-'6`).-:' Q EMERGENCY Q TEMPORARY REPAIR REPLACEMENT 0 DEBRIS 0 GRANT IN CLEARANCE LIEU LOCAL JURISDICTION er-".,---," 7/.•/ INSPECTION MADE BY REPRESENTING STATE OR PROJECT NO. ITEM OR REFERENC NO. /..":"-•' • — f . (::, r ./2 //. DESCRIPTION OF DAMAGE L44) , i, Y. 5 C 1. 4 kV' dPr, VI &AI> ...., .f Lv/ ...7"..1O;,‘ r Cl au 6rIC y., r . c via' 5, -, . .0 r rO a 4-( w:'L: f" Q P/O C. -ti wa ;.... ., / 3 /71,..)1,- r , CO //^7 �� LOCATION ;'7 i�2Mt.N+ .y M, o '' ;,., f LU •Jr DTI 57,1 6,110. ORIGINAL FACILITY SURFACE TYPE y}Sia/. rj,,... ADT ,__•hOAD [�s aloGe tri OTHER (Specify) Q FACILITY TYPE >1,...1 l - LGreco� _ ROAD BRIDGE OTHER I.EN GTHt I SURFACE WIDTH A 2.0' 2-44f) - I - I +t�,�ENOTH (Otereff) • WIDTH (Ctsb to curb) 2.00' I 1.'/ 1 i I LENGTH! WIDTH: �. HEIGHT! DIAMETER: ELIGIBLE Ll INELIGIBLE (Oho reason) Ri'COMMENDED WORK ) '/e 4r' e27 611. r° brl✓ AV 7c-1 7 c•' /. C(/ 1..1 /o; ' . . DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST /Ci 61 r'rec4 •�• �J%brls `/cam•=-r�Ji 'Ice... g;--,-7.4.-.J..7".:-'./?7 ',-�/ !;(.A, . .oO=-'' a, .-e7 4DO 5''7 SIGNATURES . (Inepeccla s,ta Mow.) I C(/.1 • ` ...`1 . �`�_.t SBPR) TOTAL ESTIMATED cosy i r �j `. ; I _ r, _.—�' `"& .(y.:2 -, s' , t;. :,i-r..-„ : -1 ISHO) MORE/PACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET USCOMM., . CI.ARATION .-)ATL OF INSPECTION PHOTO REFERENCE FORM PR -1130 "IREV. 7-41H J.S.Der PAL7'".1LNOF COMEI-'', • RE'iCN NO. BUREAU OFT OU4'L,CMRO INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23.2) STATE COUNTY EMERGENCY REPAIR El/TEMPORARY CIIICCBRIS GRANT IN REPLACEMENT CLEARANCE LIEU INSPEC''.CN I.iADE BY REPRESENTING 1. . r� STATE OR PROJECT NO. /,-""),+" LOCAL JUI;ISOICTION ITEM OR REFERENCE NO. /1/3 ': ION t i vV of Fort DESCRIPTION OF DAMAGE arta,2CrieS 44.1 at A eS vKY. c•r.l✓Cl ��tr�wt,«/ wa.'iec) ow4- o•. Ai 4p oc Vim 4:i r CIeara.ce (0(d Cr Icc .) Ll" ORIGINAL FACILITY BRIDGE OTHER `Specify) SURFACE TYPE C�I4 I FACILITY TYPE 2 -Dues ROAD SURFACE WIDTH I BRIDGE OTHER Atli I< too LENGTH (OTefeff) j WIDTH (Curb to curb) ILENGTHS WIOTHt l l INELIGIBLE (O1ee noon) 0 I i O HEIGHTI DIAMETER: RECOMMENDEO WORK P1.5e1/4,57::;/77 - „,Ze - r S `.4a.+ el (7 Cie 0'4 < e CI 1.4 r` DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST /?Cmova( -' flood, Cy J'IctHrteI Cfe4r4„ee ✓�Y 6 `�' p;7 6arsQ Lie -7/ 51/f klr,t jon, 369 SIGNA'":IAES L U. Z- (8PR1 TOTAL ESTIMATED COST IF MOR£i,SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET J USCOMM.DC 4f' "•�.t . ki10N IORM u'R•173e-- IR 1 Y. r -83I J.S: DF'f'A ' •0A!IN T OF COMMO —"fi OFF LAO OF Pt:Fn.!C Fit1 RE( -ION NC. S ,)A 1 OF INSPECTION esNOTO REFERENCE INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23. ) STATE COUNTY El EMES3ENCY RE PA.'n^ INSPECTION MADE BY - .r11/ 7 EMPORARY REPLACEMENT DEBRIS CLEARANCE GRANT IN LIEU LOCAL JUPISDICTION (, REPRESENTING f r { LOCA7ION . ) II via. en6er. rood STATE OR PROJECT NO. ITEM OR REFERENCE -1.0. ESCRIPTION OF DAMAGE /boa 04II Wo.)4QCI wdsl� ...VCbre1 Cle 1'ietee. �lao7 i0 pr:>"'rO1 .Dahl @, +e b I , tl j C Put I „� j"'/o r. e ROA^r dORGINAL FACILITY BRIDGE OTHER (SPsat1Y) SURFACE TYPE FACILITY TYPE 2-(-- es ROAD BRIDGE OTHER I I✓err destra J: t, i h:JT L..NGTHI 3uo' l'J • ELIGIBLE BUR FACE WIDTH f /$/ LENGTH (Overall) Q INELIGIBLE (O1va roes 'WIDTH (Curb to owb) 1 22 LENGTHS HEIGNTI 5/ Zr WIOTHI 2 / OIAMETE. : I If RECOMMENDED WORI(/e1�S) died,/ /mg% STruLlterc Aire/a/ C 4/vrr- a Cott ; eo 1 J i/ [iGc° r S e-e1r/✓7C/ /}roc' DETAILED ESTIMATE QUANT11'V UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST / 3e-71 .'o(.2 G 5 C S De. hr.; F? n'i0 v4./ and Pro lee-fri t CAa i„e / e le4rzeole /7"X //" C/14/c' ArcA C dulee'r e% r I dy e refa;.- a e r j✓ e /1;5 >� i-kt; r 6-i-7-d 6 l /7eit.7-2& /-3 Gr PP/ )‘ et 4.1 5 3,00. Lis, 45-0 /.00 30 C2 3I, ATURES '! ;psefta� :ingtr... oes) >_. ) • L11-��'�/ IUPRI TOTAL ESTIMATED COST T IF MORESPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET USCOMM-OC 9(138.. PI,.1 it ::cCLARATION - -. y�— FORMPN•113O- U.S. DEPAR--•ENT Us ..UMmc••---r "REV. 7-691 OUREAI: OF PUnLIC no INITIAL ENGINEER 1NSPE:(TION REPORT - P.L. 975 (PPM ?3-1) •••.�•�•• ••"• / STATE I i' • _ I DA'. - ;,I: 1 .SPECTION -. (d, :_, COUNTY • •/ i �••/. • 'HO -C ?iti ERENCE ' 1 EMERGENCY IREPAIR TEMPORARY D DEBRIS REPLACEMENT CLEARANCE REPRESENTING ,/�/.r': LOCAL JURISDICTION , ..---"N..---"N" L 1,' •�# .-- ): ••• M GRANT IN LIEU STATE OR PROJECT NO. ITEM OR REFERENCE NO. INSPECTION MADE BY 1. , , �',..` DESCRIPTION OF DAMAGE 5:p a7- wasA ouf's o4- Roca I MDT-' �._.1 ../...20 / TLocAT1oN l --1- /1 /i /e. , 1-.), !, c v ,7 ORIGINAL FACILITY SURFACE TYPE I O OTHER (3`p•cllr) FACILITY TYPE ›/C,!, 1 I ROAD NM BRIDGE ROAD BRIDGE CTHER I (.ENGTHI 19UR FACE WIDTH 1 I r�(o /e LEN OTM (O�er�1l) I WIDTH (Curb fe curb) 1 I LENGTHI WIDTH' HEIGHTI DIAMETER: 1 n EL'GI BLE INELIGIBLE (OJee reeeen, ii r ECGMMENDED WORK II ' •!./off ,� a (iii// Gt/c� �L��-•I� :Jr•.-. � /lac QUANTITY i7U < UNIT DETAILED ESTIMATE MATERIAL AND/OR DESCRIPTION UNIT PRICE COST SIGNATURES (1n.pectinp EndInesr.) C. r„ 6 ,rv41--17"•-7 71— w 9 -3Q -e, IBPRI (SRO) D..SO .0vo TOTAL ESTIMATED COST $ IFMORE SI CE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET USCOMM-DC ,'e.1 FORM PR -1130 -- „(REV. 1 -es) J.S. DEPANTI.lENT OF COMM:nCE 3URk•:%• OF Putl1_1C REGION NO. I.- 7,.' . GF 1r.PECTION .•; L OF DECLARATION PHOTO REFERENCE INITIAL ENGINEER INSPECTION REPORT - P.L. 875 (PPM 23.2) STATE COUNTY • EMERGENCY Rc PAIR TEMPORARY D DEBRIS n GRANT IN REPLACEMENT CLEARANCE LIEU LOCAL JUs;',DICTIOON INSPECTION WADE BY REPRESENTING I f/ LOCATION p ./ NPr !J,-, Syr"'. 7i3 -e• I17 2'7,?v•''', ;;, 6ree,../.,/ •v 2 • �il/P5 eir • STATE OR PROJECT NO. ITEM OR REFERS C£ NO. DESCRIPTION OF DAMAGE ,G'i/ %rr'.a . 4-1.•""/'!"/ 1.267' .7' 1 /r' ` a/'CPC.[^'/fie �)!/j '.r.:v,"i ORIGINAL FACILITY ROAD �GRIDGE ROAD LJ ,t,(STHER (SpeeflY) C% oh � 1,5 SURFACE TYPE �� —� �/—`_+,, ..J ��'• FACILITY TYPE BRIDGE L ENOTHI .-- j ELIGIBLE C.] INELIGIBLE (OD* meson) ISURFACE MOTH /2—'22 LENGTH (Overall) :WIDTH (Curb f0 curb) 1/rie?b1e /6 - 20 OTHER LENGTMI WIOTHI r,a 61 LJ HEIGHTt DIAMETER: IE_+ir /av REt.70MMENOED WORK ✓ C /7 (-s`7,/'7/7r.'/ Zoe, DETAILED ESTIMATE QUANTITY UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST .5. C, Cr et -00-770 Ch. -W7 / C/e. 0=4 -. r ,Br, 7. /y gym• .,v/ . pritm.1'� L. 5 • L.S. S. / O 0 • SO S So /6 c /225 47 SIGNATURES (Inspecting Engineers) C,) ./ (BPR) TOTAL r 1 1 ESTIMATED Seg J COST rJ ! (SND) CIFMOI SPACE IS REQUIRED USE REVERSE SIDE OR SEPARATE SHEET USCOMM•OC '. �•+'ae 0?t•'. . -C1..ARAtION p, ..- FORM P3-1130 .-, ' U.S. DEPARTMENT OF COM1.1-.3CF. J•REV. 7•03IJ -BUREAI.• OF PUIll. iC ROA"` REGION NC, - �_ 1-0-A7.- E. .... ., .:CTION _ - INITIAL ENGINEER INSPECTION REPORT - P.L. 875 STATE - ,/-7"-; r/., PHOT:, 1;,)-ERENCE (PPM A3 -J) COUNTY / ,/,./ EMERGENCY ❑ TEMPORARY DEBRIS O GRANT IN REPAIR REPLACEMENT CLEARANCE LIEU LOCAL JU1 G 1 710N ', j .7• / , -7 /,% J INSPECTION MADE BY ��--REPPRRIESENTING . —. 1 ! � B. P /i . STATE OR PROJECT NO. ITEM OR RE EREN/CE-JO. 9f7r, ` //)..-.=/ L DESCRIPTION OF DAMAGE �r'%: /!.6 ,%J�/7) c V / • , ,' r-7.-/, ... /' •"' 42e" -Z•'/- / J /�Y°1%%df/7,1/ igr/4-i -.' -' .C'`1 •.-•'/- <-...rr f,.....e..4' V I 5 ,,.....-.--r-ri 0 e) ;,:t / —; 2. , / J /� ,f ! 3. I LOCATION ORIGINAL FACILITY •.•••••••••OTHER(�'peclh') C.jROAD BRIDGEno SURFACE TYPE I ADT -1> FACILITY TYPE 11Oj ROAD BRIDGE OTHER , ...ENGTHI I SURFACE WIDTH v ..,, •..-r , :;` + /S -2r'' ' I LENGTH (Over.!!) ;WIDTH (Curb le curb) I !/.-Vr/1�G/' : ci — O' I LENGTH' WIDTH: HEIGHT' DIAMETER' IN-ZLiGIBLE O INELIGIBLE (aloe r•.eon) RECOMMENDED WORK .', , . ' v v r- /.2.— 1.) I'/ -• 4i✓f,: _li r' .1. ri . ✓,,c' i ii r✓r i L, s DETAILED ESTIMATE iI QUANTITY rna! UNIT MATERIAL AND/OR DESCRIPTION UNIT PRICE COST / C. 5. C• 5. .Or6ri:s ,k17 •--? -90 vim/ ' 7G._.". 4----",',..v./i- ,/ ;/ry i-:-.Vi/s i g7f G. 5 . Z , 5 S. / S 0 /S7 / Z --.5,— i SIGNATURES I an* pa a find finQ Moore) C",, Q/� lj _4 , ;--�, (BPR) TOTAL ESTIMATED -_ COST S .. �..... - • i ��.,... / - - - IF MORE SP CE IS REQUIRED USE RE Weld County, Colorado, continued Category "Vs Mikes, Levees and drainage facilitiess I concur with the cost estimates contained in the attached Corps of Engineers' report dated July 13, 1965. $440.03 ice- z� Auti4 issd Representatives( Chairman. Bassi of County Commissioner 15 JULY 1965 Dear Sirs inclosed herarlth is an *Waste for Sold County. District do. O. in the amount of f4.%65.iki fox Catageries "!" and "ire • stncersly yours, 1 anal as (in dup) L. F. OTTO flood Director ATTACH &IIF,T f04 W COUNTY. DISTRICT NO. Category "B" - Protective work before and during the flood 1. Protect bridge, east of Evans, T..35 Dragline rental (invoice) 2. Protect bridges at various places in county, day and night work for approx. 30 moon $125.00 overtime/son 3. Protect bridge on Platte River east of *attenburg, Contractor equipment - Clam shell & crew • est(contract) 4. Oat roadbed to protect road bridges, etc. a. + ail• E of Barnesville on Crow Creek, dragline & crow b. 3/4 mile E of Barnesville on Crow Creak, dragline A crew c. 1 mil* E of Barnesville on Crow Creek, dragline 8 crew d. 2 mile h & :; mile W of Kuner on Crow Creek, dragline I crew S 260.00 3,750.00 315.00 50.00 50.00 50.00 50.00 TOTAL CATHY "B" 54,525.00 Category "D" - Cleaning channels 1. Removed bridge from Lenoir** Croak channel, mile south of Gateton. D-8 tractor, lowboy and crew, 4 hrs equals 110.00 2. Removed bridge from Lonetree Creek channel, 2 miles south end + mile west of Galeton, same crow as above, 8 hrs equals 3. Removed bridge from Eaton 82 channel, 1 mile south and k mite west of Galetsn, sass crew as above, 4 hrs equals 220.00 110.00 TOTAL CA1E17OR "D" $440.00 }1LLsits 4 7/14/65 P490 40 Date of sclaratien S,ogion tea. Dot. of Intimation i oeti INSPECTION 1' ?T • P. L. 075 Stator COLORADO County • aRsrg.ncy +aspor*ry Debris j rant in si JUrl let on 2nsp.at ant t )14211i1.pr*.sr tl Stets or t' 9 ProAct Na. . or Pa . o. IA 1alotazt on* _9f Teat Dosoripflon of Wing, 3. .iQ n &x r, WA ntr, Colorado See, att.ch.d shoots for description Location field dounty. District IS Soo attached sheet cgiasl Facility raw RoadUOthor Spool n. Art4514 Li Lit* Pi I scovers ( curb) )(Q)jo Par tho following rases Facility Type Cr Veit X eligible ln.ligible $.co 3.d *obit See attar wets Lo #to p&i 4040.4911, 44,11111 Yrkk$ 4$04.10 PoiscatIptioft 1st 'irks ?.ott Category *A* Category *IP Catogery "D" None Set .ttacho4 detail short See attached detail sheet (Cleaning Channel) .1• $4,525.00 L. 5. 440.00 Hello