2003, 06-12 Avista Notice of Hazardous ConditionsAm_
Utilities
Customer Name
i�
Address
NOTICE OF HAZARDOUS CONDITIONS
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
r� /�-k' �y�� Phone Number
I °l2A l /o�-5 City '•v
S-0308 (06-01)
.HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
of life. The equipment has been disconnected or left inoperable, and shall not be turned back on until such repairs have been completed
by a qualified HVAC dealer, contractor, or service agency, and the equipment has been brought up to current safety standards. Do not
attempt to use this equipment until it has been repaired.
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❑ Apparent cracked or restricted heat exchanger ❑
❑ Damaged appliance connector
J Damaged or disconnected vent ❑
❑ Gas leak at gas equipment ❑
Location.
A gas leak in your house piping in the amount of
with all known appliances off
Insufficient combustion/ventilation air
Other
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CFH
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Meter Left ❑ Off 0 On Meter Number
have read, understood and acknowledge receipt of this notice.
Customer Signature
Meter Read
❑ Owner ❑ Tenant ❑ Agent
❑ Refused to Sign
Service Representative
White Copy -Customer Yellow Copy -Attach to Service Order
Date
6.- e L —v J
Time
Pink Copy- Authority HavingJunsdicoan Hard Copy -Appliance
am/pm