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© 2004-2016 DKF Solutions Group All rights reserved. City of Redwood City: Overflow Emergency Response Plan B-4 Side 1 Sanitary Sewer Overflow/Backup Response Packet Sanitary Sewer Overflow Report INSTRUCTIONS: Complete all items EXCEPT those that are shaded gray SSO Category (check one):  Category 1: Discharge of untreated or partially treated wastewater of any volume resulting from a sanitary sewer system failure or flow condition that either (1) Reaches surface water and/or drainage channel tributary to a surface water; OR (2) Reached a Municipal Separate Storm Sewer System (MS4) and was not fully captured and returned to the sanitary sewer system or otherwise captured and disposed of properly.  Category 2: Discharge of untreated or partially treated wastewater greater than or equal to 1,000 gallons resulting from a sanitary sewer system failure or flow condition that either (1) Does not reach surface water, a drainage channel, or an MS4, OR (2) The entire SSO discharged to the storm drain system was fully recovered and disposed of properly.  Category 3: All other discharges of untreated or partially treated wastewater resulting from a sanitary sewer system failure or flow condition  Spill from Private Lateral (specify):  Single Family Home  Multi-Family Home  High Density Residential (5+ units)  Food Service Establishment (FSE)  Mixed Use Property  Industrial Property  Commercial Property  Public quasi-public institution (hospital, schools, fire department, etc.) IMMEDIATE NOTIFICATION: For a Category 1 SSO ≥1,000 gallons reaching surface waters, CalOES must be contacted within 2 hours at (800) 852-7550. A. SSO LOCATION SSO Location Name: Latitude Coordinates*: Longitude Coordinates: Street Name and Number: Nearest Cross Street: City: Zip Code: County: SSO Location Description: B. SSO DESCRIPTION (Complete Volume Estimation Worksheets and/or refer to Field Guide as needed for estimations.) SSO Appearance Point (check one or more):  Force Main  Gravity Mainline  Lateral Cleanout (Private)  Lateral Cleanout (Public)  Inside Building or Structure  Manhole  Pump Station  Lateral (Private)  Service Lateral or Lower Lateral  Other Sewer System Structure (specify): Were there multiple appearance points?  No  Yes, number of appearance points: Did the SSO reach a drainage channel and/or surface water?  Yes (Category 1) No If the SSO reached a storm sewer, was it fully captured and returned to the Sanitary Sewer?  Yes No (Category 1) Was this spill from a private lateral?  Yes No If YES, name of responsible party: Final Spill Destination:  Surface waters other than ocean  Drainage channel  Building/structure  Separate Storm drain  Combined storm drain  Paved surface  Unpaved surface  Street/curb/gutter  Other: *Provide name(s) of affected drainage channels, beach, etc.: Total Estimated SSO volume (in gallons – 1,000gal or more = Category 1): gallons Est. volume that reached a separate storm drain that flows to a surface water body: gal Recovered: gal Est. volume that reached a drainage channel that flows to a surface water body: gal Recovered: gal Est. volume discharged directly to a surface water body: gal Recovered: gal Est. volume discharged to land: gal Recovered: gal Calc. Methods: Eyeball Photo Comparison Upstream Lat. Connections Area/Volume (include sketch/photo with dimensions) Other (describe): C. SSO OCCURRING TIME (complete Start Time Determination Form and then complete information below) Estimated SSO start date: Estimated SSO start time: Date SSO reported to sewer crew: Time SSO reported to sewer crew: Date sewer crew arrived: Time sewer crew arrived: Who was interviewed to help determine start time? Estimated SSO end date: Estimated SSO end time: * If multiple appearance points, use the GPS coordinates for the location of the SSO appearance point closest to the failure point/blockage. 6.2.A. - Page 143