2003, 06-18 Notice of Hazardous Conditions#7vISTA'
Utilities
Customer Name
NOTICE OF HAZARDOUS CONDITIONS
Address
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
S-0308 (06-01)
Phone Number
City r°4)1<- el" (71,2 11-4rL S
U 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 eauioment until it has been repaired.
1-1-c" (\s' -r rc._ -k -c
U Apparent cracked or restricted heat exchanger
❑ Damaged appliance connector
❑ Damaged or disconnected vent
Gas leak at gas equipment
V 4 1 yr //,
Location ' `s r1 ✓z Aft-
❑ A gas leak in your house piping in the amount of
with all known appliances off
Insufficient combustion/ventilation air
Other
CFH
Meter Left ❑ Off 0 On Meter Number
I have read, understood and acknowledge receipt of this notice.
C stomer Signature
Setvice Representative
Meter Read
Owner U Tenant ❑ Agent
❑ Refu • d to Sign
Date
WhiteCopy—Customer Yellow Copy—Attach toSem rder Pink Copy -Authority Having Jurisdiction
Time
Hard Copy—Appliance
12 `/ am/p6