2008, 07-03 Notice of Hazardous Conditionsioa VISTA
Utilities
Customer Name
Address ,e"
TYPE OF
NOTIFICATION:
NOTICE OF HAZARDOUS CONDITIONS
43-
/15-03 ; F"2 -c=' /cpa. •
Equipment Type:
CONDITIONS
FOUND:
Phone Number
City
1
5-0308 (11.05)
9z F • 54 942
IUAZARD 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
ttempt to use this equipment until it has been repaired.
� LJ�/C—'A/
l
4s i"0 iZL �(/'� �lt1/�L Location �
' parent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of CFH
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
with all known appliances off
❑ Insufficient combustion/ventilation air
❑ Other
t JJ
Llt
L Ue%LLI
DG
Meter Left ❑ Off rM On
Meter Number
1 have read, understood and acknowledge recei tof this notic
fD
Customer Signature^�
Service Representative
c�� r-
WhiteT.VVL&t Customer Yellow Copy—Attach to Service Order
Meter Read
❑ (Oyxner ❑ Tenant ❑ Agent
❑ Refused to Sign
No
Date i --.z 7' i -h Time
7-3-0
Pink Copy— Authority Having Jurisdiction Hard Copy—Appliance
-am/pm