2003, 04-15 Notice of Hazardous ConditionsVISTA z-
• -
•- - ' Utilities
Customer Name '
Address
TYPE OF
NOTIFICATION:
NOTICE OF HAZARDOUS CONDITIONS
i
�/OOS S ' ""rT°
Coc.cyi-t-AC 'N t City • ,. '/C`f'-'t^-C colo - `6C007
8-0908(06-01)
Phone Number -7-5 ' �) e'7.2v
Equipment Type:
CONDITIONS
FOUND:
❑ 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 ❑ A gas leak in your house piping in the amount of
❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment !]Other
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Location.
CFH
Meter Left ❑ Off On Meter Number
Meter Read
I have read, understood and acknowledge receipt of this notice. ❑ Owner C5 Tenant ❑ Agent
Customer Signature �`(/ y/ _ /
Service Representative ��" Date ///`�/UiTime `
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