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2004, 10-17 Notice of Hazardous ConditionsAPi VISTA' Utilities NOTICE OF HAZARDOUS CONDITIONS Customer Name �' �G�a•/tee C Address ,/, / o0Ca / TYPE OF NOTIFICATION: Equipment Type: CONDITIONS FOUND: Phone Number City S0308 (08-01) /(- /893 ❑ 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. �u„,,, Location • •�� 'AZZ4 4 -,Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of with all known appliances off -0S• Insufficient combustion/ventilation air ❑ Other ❑ Damaged appliance connector ❑ Damaged or disconnected vent ❑ Gas leak at gas equipment CFH ziY< k lGl - %IT ti- '—i - ,•�ti aZr 401- ..AWIA Meter Left ❑ Off ..12K7In e Meter Number Meter Read I have read, understood and acknowledge receipt of this notice. ❑ Customer Signature Service Representative White Copy - Customer Yellow Copy - Attach to Service Order Owner ❑ Tenant gent Date 4/Citi ❑ Refused to Sign -re 14 U 4” Time amipm • Pink Copy - Authority Having Jurisdiction laird Copy- Appliance