2004, 05-25 Notice of Hazardous Conditions1,17 -ins
UtilitiesNOTICE OF HAZARDOUS CONDITIONS
Customer Name GO.[L /L ��y'�C�7r
Address �' 30 3 / is 4 o, 4
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
S-0308 (08-01)
Phone Number 2 /7' f 05/ )
City .J 4,0 /4 [ [ czy
❑ 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 egpjpment until it has been repaired,
(�4 S L/f2nb4 c Com' Location' w•Q Sqtr-'/s,6 T'
❑ Apparent cracked or restricted heat exchanger 0 A gas leak in your house piping in the amount of
O Damaged appliance connector with all known appliances off
O Damaged or disconnected vent 0 Insufficient combustion/ventilation air
❑ Gas leak at gas equipment 0 Other
CFH
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CAI r.
%h//ST 1.1i 50 � iC a k/ Ilk fl T 6.)6 . 4/4 e) / /A75 -fie, c r
a
Meter Left 0 Off D On Meter Number Meter Read
1 have read, understood and acknowledge receipt9f this notice. D Owner 0 Tenant 0 Agent
0 Refused to Sign
Customer Signature'
Service Representative
White Copy - Customer
Yellow Copy - Attach to Service Order
Dated -.5 J� Time
Pink Copy - Authority Having Jurisdiction Hard Copy- Appliance
7./0 anviDi
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Utilities nn
C'OGL /c if�rC K c 7
Customer Name
Address
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
NOTICE OF HAZARDOUS CONDITIONS
S-0308 (08-01)
Phone Number Z17 T V7 v
.3O3 /1-/c: JONQ4Q City J 4. //A[�7�/
❑ 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.
t j 4 S 114A/ic Location• - TC' f,%r or/
❑ Apparent cracked or restricted heat exchanger
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
❑ A gas leak in your house piping in the amount of
with all known appliances off
❑ Insufficient combustion/ventilation air
❑ Other
CFH
:� IC Ce9A//t/Cc are_ TA/ i U Uca LL
— A/o Nv,-i tJc= .
144 t14... I L1 ( C'o/4 .
\deFe`tC
/)/aS r //4'A
% 114 UKGN •, ire 74 L c_ ems° /A/57-4 e- , fc '5'- L NC
LL X C�Ort/. 14/ 7-A1 C 0C r7c f/CA/.
Meter Left ❑ Off
4.. On
Meter Number Meter Read
I have read, understood and acknowledge receiiiptof this notice.
Customer Signature
4
❑ Owner 121 Tenant
Service Representative
&VA'
White Copy - Customer Yellow Copy - Attach to Service Order
❑ Agent
❑ Refused to Sign
Date z - • (7,/ Time
Pink Copy - Authority Having Jurisdiction Hard Copy - Appliance