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2003, 10-25 Notice of Hazardous Conditions
4u VISTA' Utilities) %/. (NOTICE OF HAZARDOUS CONDITIONS Customer Name Y� Address i • //W. "n4214... iin \/ \ 11 )TYPE OF i].HAZARD The conditions noted below[cpnstitute an i Tm e disaazar an may result in oma t hazard d It property d gaersona in, personal injury or loss 5-0308(06-01) i"(..ftOW/l/it ,V / Phone Number 'l `i' -r 09 ?80 30 City 5/-49. ll c, lA NOTIFICATION: }} • Equipment Type: CONDITIONS FOUND: 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-s`ervice agency, and the equipment has been brought up to current safety standards. Do not attempt to use this equipment until it has been repaired. \ • Location. e heat exchanger ❑ Damaged appliance connector ❑ Damaged or disconnected vent ❑ Gas leak at gas equipment arent cracked or restricted ❑ A gas leak in your house piping in the amount of with all known appliances off ❑ Insufficient combustion/ventilation air ❑ Others CFH / 1/ / /i/.%%d< £' //Ufl & •Cietat-tc /r/ „ / r /_ / / I/ I is' . ;tt4-1' 7A- F07X—P / V -4--V' . tctitZl-t (fov /.1 ,V inn . /i., n!• r/ t r -rn-c - r V K iii' 1."1l.(/ttiGY cGe tt'C -t- MeterLeft)©`Off ❑ On Meter Number Meter Read \ „,..-- I I have read, understood and acknowledge receipt of tthhis notice. -C1 Owner ❑ Tenant ❑ Agent da -Customer Signature " 0 Refused to Sign / / r r cmc. l�/ , //�/trl /4-2 ¶ /'dJ Service Representative Date Time amOn White Copy -Customer Yellow Copy -Attach to Service Order Pink Copy- AuthontyHav,ngJunsdiaeon Hard Copy -Appliance