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