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<br /> "3.~ <br />0 ~ ~ <br /> ...= <br /> o.s <br /> H <br /> ] .. <br /> ~ ~ <br /> ",- <br /> ~~ <br /> !d <br /> ]ri ~ <br /> d '" <br /> u <br /> " <br /> h " C <br /> ~a ~ <br /> .. ~~ ~ <br /> :c '" <br /> l> <br /> .. '0 ~u ~ <br /> ... ~ l~ <br /> c ] <br /> Q U ~~ <br /> i: ~ H ~ g <br /> .. ~ ~ <br /> .. .. .5 :s ] <br /> c 0 l.~ I <br /> Q ~ <br /> U ~ " <br /> Cl. ':l! .5!"O\O <br /> E .~ o u . <br /> ~ 8- ~ l~ <br /> ::l '" . . ~ <br /> tii ~ ~ lH <br /> ~= t <br /> t.g.t <br /> 'C~ .l HE <br /> ~~ <br /> ~.Jl P .~!~ <br /> <:I ~;,; <br /> !~l d! a1!:g <br /> 8 g .Jla~;;; <br /> ~:2~ ii ;B.9'O <br /> i3 Is B ]!l!l~ <br /> u ti: ~ ~~ <br /> ~~~ ~ ~ Pi <br /> H 9:0;0:; <br /> .g~ g .sa ]n.o <br /> ~~1 n ;aa! <br /> .~!~ .~ .... ]"'''' <br /> "g' ~~ ~ . <br /> ~~] ~~ ~ <br />0 <br /> <br /> <br />Applicant: <br /> <br />Applicant Representative: <br /> <br />FEMA Representative (if available): <br /> <br />State Representative (i' available): <br /> <br />(... <br />a~ <br />:~~;~~~;;~~~~~i~~~~~~~~~~i~~~~~~~~;i~~~;g <br />liil <br />,!- <br /> <br />~ <br />~- <br />sl~~~~~~~~~~~~mmg~~~~~~~~m~~~~~~~~~~gm~~~ <br /><l.C <br />e=- <br />ti <br /> <br />. <br />e.. <br />.2'2 <br />:~~d~~d~-~~~~~~~~~~~~~:~~~~~~~~:~~~~;~~;;~ <br />j'" <br />,!8. <br /> <br />i- <br />;1~~~m~~~~~~~~~~~N~~~~~~re~gM~~~~~~~~~;~~~~ <br /><l.c <br />e=- <br />" <br />Iii <br /> <br />Hazardous Stump Worksheet <br /> <br />Date: <br /> <br />Signature: <br /> <br />Signature: <br /> <br />Signature: <br /> <br /> GPS Fill for <br /> Physical Location Description of Hazard Decimal Degrees Tree Size Eligible Debris Comments: <br /> Street Address, Road, Cross Facility 00.000000 (Diameter) Stumps (see attached sketch, photo, <br /> Street, etc. ROW, Park, Inches etc.) <br /> City Hall, etc. <br /> YES NO Latitude Longitude YES NO CY <br /> (N) (VV) <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />Prime Contractor Name: I TDSRS Location: <br />Truck Comoanv Name: I Loading Site Monitor Signature: <br />Truck Driver Name: I <br /> <br />o <br /> <br />'Note: Tree diameter measured 2 feet above ground level. <br />"Refe~ence Stump photograph in comments. <br />Photograph with superimposed yardstick required with each stump. <br />