HomeMy WebLinkAbout2004, 03-12 Notice of Hazardous Conditionsl
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NOTICE OF HAZARDOUS CONDITIONS
Customer Name K 1csa(/1) f? n%Ystir ]1 1 and /f/ •
Address--55.—aT.Jt✓' ..^'7'r. -tom Y
TYPE OF
NOTIFICATION:
Equipment Type
CONDITIONS
FOUND:
,S-0308 (08-01)
Phone Number 92C,r 7. 7970-0
City rSe� 7 •
❑ 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 touse
this eomoment until it has been repaired. /]
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❑ Apparent cracked or restricted heat exchanger
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
❑ 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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Meter Left , ❑Off O On
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I have read, understood and acknowledge receipt of this notice.
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Meter Number Meter Read
Customer SignatureV
Service Representative
`a' Owner
Mine Copy - Customer Yellow Copy - Attach to Service Order
❑ Tenant ❑ Agent
❑ Refused to Sign
Date '/Z •.17Tme
Pink Copy -Authority Having Jurisdiction Hard Copy -Appliance