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2004, 06-01 Notice of Hazardous ConditionsAJV/STA' Utilities Customer Name Address 7"Yi TYPE OF NOTIFICATION: Equipment Type: CONDITIONS FOUND: NOTICE OF HAZARDOUS CONDITIONS 11-1 Phone Number 6 -Lt: jJA— ..a 1 city ) ji" 7V S-0308 (08-01) /J. —`39'62 ZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss of life.l he 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. ❑ Apparent cracked or restricted heat exchanger ❑ Damaged appliance connector ❑ Damaged or disconnected vent ❑ Gas leak at gas equipment t f fr t' Location. LP i/ ` U":5- $- Al gas leak in your house piping in the amount of with all known appliances off ❑ Insufficient combustion/ventilation air ❑ Other CFH FP 1 } vli4J 1,11,1f LA./IL 1,4 Meter Left ❑ Off Meter Number Meter Read I have read, understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent I' r '• -Customer Signature ❑ I �; Service Representative \J ( .. Date White Copy — Customer Yellow Copy — Attach to Service Order fusel d to Sign Time a[ti/pm `) Pink Copy — Authority Having Jurisdiction Hard Copy—Appliance