2003, 10-27 Notice of Hazardous ConditionsAult
AridInn
Utilities
, Customer Name h! % -TA oM XI -5.d Phone Number
40 tL Al /4 svL.'&/(
NOTICE OF HAZARDOUS CONDITIONS
Address
TYPE OF
NOTIFICATION:
Equipment Type
CONDITIONS
FOUND:
---�".r
City _5-
6-0308(06-01)
�i 2,0L0
0 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.
66/0QJ Location: ea -re #11* -1
IApparent cracked or restricted heat exchanger
'❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
r
❑ A gas leak in your house piping in the amount of
with all known appliances off
❑ Insufficient combustion/ventilation air
❑ Other
CFH
/ w ° ' .!j n don bur- o,J /o ` 7` S- • S 4 _o /-• c e c#
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Meter Left ❑ Off ❑ On Meter Number
1 have read, understood ---arid acknowledge receipt of this notice.
Customer Signature r"/ti) I it-7.f1r.1'%1.,
-
Service Representative 6 Z
Meter Read
Z](Owner ❑ Tenant
❑ Agent
❑ Refused to Sign
Date A°' -) -G3 Time 5--6 am/p�
White Copy -Customer Yellow Copy-Attachto Senesce Order Pink Copy-AutontyHaving Junsd¢don Hard Copy- Appliance