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ARIZONA DIVISION OF EMERGENCY MANAGEMENT DATE PRELIMINARY DAMAGE (Arizona)

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FORM # AZ PA 204-18
ARIZONA DIVISION OF EMERGENCY MANAGEMENT DATE
PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
PART I — APPLICANT INFORMATION
COUNTY NAME OF APPLICANT NAME OF LOCAL CONTACT PHONE NO.
PART II — SITE INFORMATION
KEY FOR DAMAGE CATEGORY (Use appropriate letters in the "category" blocks below)
a. DEBRIS REMOVAL d. WATER CONTROL FACILITIES
g. OTHER (Parks, Recreational Facilities,
etc.)
b. PROTECTIVE MEASURES e. PUBLIC BUILDINGS
c. ROADS AND BRIDGES f. PUBLIC UTILITIES
SITE CATE
LOCATION (Use map location, address, etc.)
NO. GORY
DESCRIPTION OF DAMAGE
IMPACT: % COMPLETE COST ESTIMATE
SITE CATE-
LOCATION (Use map location, address, etc.)
NO. GORY
DESCRIPTION OF DAMAGE
IMPACT: % COMPLETE COST ESTIMATE
SITE CATE-
LOCATION (Use map location, address, etc.)
NO. GORY
DESCRIPTION OF DAMAGE
IMPACT: % COMPLETE COST ESTIMATE
SITE CATE-
LOCATION (Use map location, address, etc.)
NO. GORY
DESCRIPTION OF DAMAGE
IMPACT: % COMPLETE COST ESTIMATE
NAME OF INSPECTOR AGENCY OFFICE PHONE
NO.
HOME PHONE
NO.
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ARIZONA DIVISION OF EMERGENCY MANAGEMENT DATE PRELIMINARY DAMAGE (Arizona)

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Completed 20 July 2020

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