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© 2004-2016 DKF Solutions Group All rights reserved. <br />City of Redwood City: Overflow Emergency Response Plan B-7 <br />Page 1 Sanitary Sewer Overflow/Backup Response Packet <br />First Responder Form <br /> <br />Fill out this form as completely as possible. <br />Ask customer if you may enter the home. If so, take photos of all damaged and undamaged areas. <br />PERSON COMPLETING THIS FORM: <br />Name: <br />Title: <br />PHONE: <br />DATE: <br />TIME: <br />TIME STAFF ARRIVED ON-SITE: <br />DOES THE CUSTOMER WANT THE CITY TO CALL A CLEANING CONTRACTOR?  Yes  No <br />IF NO, complete the Declination of Sewage Cleaning Services form. <br /> <br />DID CUSTOMER CALL CLEANING CONTRACTOR?  Yes  No <br />If YES, name of contractor: <br /> <br />RESIDENT NAME: <br /> Owner <br /> Renter <br />IF RENT, <br />PROPERTY MANAGER(S): <br />OWNER: <br />STREET ADDRESS: <br /> <br />CITY, STATE AND ZIP: <br /> <br />PHONE: <br />STREET ADDRESS: <br /> <br />CITY, STATE AND ZIP: <br /> <br />PHONE: <br />Is nearest upstream manhole visibly higher than the drain/fixture that overflowed?  Yes  No <br /># OF PEOPLE LIVING AT RESIDENCE: <br />Approximate Age of Home: # of Bathrooms: # of Rooms Affected: <br />Approximate Amount of Spill (gallons): Approximate Time Sewage Has Been Sitting (hrs/days): <br />Numbers of Photographs or Videos Taken: <br />  Photographs  Video <br />Where are photos/video stored? <br /> <br /> <br />Does property have a Property Line Cleanout or BPD?  YES  NO  Unknown <br />If yes, was the Property Line Cleanout/BPD operational at the time of the overflow?  YES  NO  Unknown <br />Have there ever been any previous spills at this location?  YES  NO  Unknown <br />Has the resident had any plumbing work done recently? <br /> If YES, please describe: <br /> <br /> <br /> YES  NO <br /> <br /> <br /> <br />GO TO PAGE 2 <br /> <br /> <br />6.2.A. - Page 148