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DEBRIS REMOVAL DEBRIS REMOVAL COUNTY CITY Page of

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					     DEBRIS REMOVAL                       COUNTY/CITY:_________________________________________________ Page_______of_______
DAMAGE ASSESSMENT REPORT                  TYPE DISASTER:_______________________________Date of Occurrence:____________________
    (Instructions on Back)                DAMAGE ASSESSMENT TEAM:__________________________________Date:________________
                                           AMOUNT     PROPERTY AFFECTED ( )        TYPE ( )




                                            Concentrated


                                                            Disbursed


                                                                         Public


                                                                                   Private


                                                                                              Agriculture

                                                                                                            Materials
                                                                                                            Building

                                                                                                                        ion
                                                                                                                        Trees/Vegetat

                                                                                                                                        Gravel
                                                                                                                                        Rock, Silt,
LOCATION AND DESCRIPTION
(Facility affected, roads, bridges,                                                                                                                    Estimated    For State Use
drainage, water, sewer and building                                                                                                                    Amount in        Only
access                                                                                                                                                Cubic Yards


                                           (2)             (3)          (4)       (5)        (6)             (7)         (8)             (9)             (10)           (11)
                  (1)




                                 Totals




MEMA DA-4 (12/01)

				
DOCUMENT INFO
Lingjuan Ma Lingjuan Ma MS
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