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© 2004-2016 DKF Solutions Group All rights reserved. <br /> <br />City of Redwood City: Overflow Emergency Response Plan B-5 Sanitary Sewer Overflow/Backup Response Packet <br />Lateral CCTV Report <br /> <br />PLEASE COMPLETE AS THOROUGHLY AS POSSIBLE <br />PERSON COMPLETING THIS FORM: DATE: <br /> PHONE: <br />CAMERA TYPE: LOCATION OF CAMERA ENTRY: <br /> <br />LOCATION OF CAMERA STOP: <br /> <br />DESCRIBE AREA TV’d: <br /> <br />UPSTREAM MANHOLE #: <br />AFFECTED PROPERTY STREET ADDRESS: <br /> <br /> <br />CITY, STATE AND ZIP: <br /> <br /> <br />PHONE <br />WEATHER AT TIME OF CCTV WORK: <br />PLEASE CHECK ALL THAT WERE DISCOVERED – Describe Extent & <br />Location Using Camera Entry Point As Reference: <br /> <br /> Broken Lateral – Describe: <br /> <br /> Depth: <br /> <br /> Roots – Severity: ☐ Light ☐ Moderate ☐ Heavy <br /> <br /> Grease – Severity: ☐ Light ☐ Moderate ☐ Heavy <br /> <br /> Sag – Describe: <br /> <br /> Depth: <br /> <br /> BPD – Describe: <br /> <br /> Location: <br /> <br /> Cleanout – Describe: <br /> <br />Location: <br /> <br /> <br /> Joint/Junction – Describe: <br /> <br /> Depth <br /> <br /> Grade – Describe: <br /> <br /> Grit – Severity: ☐ Light ☐ Moderate ☐ Heavy <br /> <br /> Other – Describe: <br /> <br />TIME OF OVERFLOW: <br /> <br />TIME BLOCKAGE RELIEVED: <br /> <br />TIME LATERAL TV’d: <br />DEPTH OF LATERAL: <br />RECOMMENDED <br />FOLLOW UP WORK ACTIONS: <br />Mark for USA location? ☐ Yes ☐ No Lateral Locations Marked in Green Paint? ☐ Yes ☐ No <br />SIGNATURE OF EMPLOYEE PERFORMING TV WORK: <br /> <br />DATE <br /> If applicable, place completed form in Sewer Backup Packet and follow routing instructions. <br />6.2.A. - Page 145