2004, 10-18 Notice of Hazardous ConditionsIW
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�uvulISTA • Utilities NOTICE OF HAZARDOUS CONDITIONS
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Customer Name Alit cletirtA \�?''i� Phone Number ` A 892 ..✓!;
Address d /non/ a ,p ,%7�",
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TYPE OF 14 -HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, persoal injury, or loss
NOTIFICATION: rf fife. 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 eouipment until it has been repaired.
Equipment Type: 9n' P-44- Location /' van .1/.. -. n
S:108(08-01)
City _C-21 ter•e2r.4 /AZ -A&
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CONDITIONS ❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of
FOUND: 0 Damaged appliance connector with all known appliances off
0 Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
0 Gas leak at gas equipment 'GI' Other
CFH
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Meter Left 0 Off IbrOn Meter Number Meter Read
I have read, understood and acknowledge receipt of this notice. - O Owner ❑ Tenant 0 Agent
Customer Signature 111J1,11 , d//,„p"�- 0 Refused
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Service Representative In PrR Date it).. --g-4 .6 y" Time
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White Copy -Customer Yellow Copy - Attach to Service Order Pink Copy - Authority Having Jurisdiction Hard Copy -Appliance