HomeMy WebLinkAbout2003, 10-10 Permit: 09000021 Notice of Haz. Conditions �fVISTA®
NOTICE OF HAZARDOUS CONDITIONS S-0308(06-01)
Utilities
Customer Name Phone Number
Address • / ?wO 7 I)/ ti i. j /r„)c' City '' / G:=&A/ /C'<ti c 5 LilleW
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TYPE OF ❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage,personal injury, lop
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NOTIFICATION: 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.
Equipment Type: ., -/'l j1 n '''1 l ii._ ('4"74`1/✓ Location: ,
CONDITIONS 0 Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of CFH
FOUND: ❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment ❑ Other
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Meter Left ❑ Off 4 On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. ❑ Owner '(Tenant ❑ Agent
Customer Signature -- ` ;,r' '1' r ❑ Refused to Sign
Service Representative _ -2—a----- Date /� '�� �� Time // "' ."1,
Service
White Copy-Customer Yellow Copy-Attach to Service Order Pink Copy-Authority Having Jurisdiction Hard Copy-Appliance \\