HomeMy WebLinkAbout2004, 03-01 Notice of Hazardous Conditions Ani_
loaf VISTA® NOTICE OF HAZARDOUS CONDITIONS s-0308(08-01)
- Utilities _
Customer Name 1 A114" -a i'? fa Phone Number • ..7 /- If 5 i
Address ,--,..�" c 4,,,,_,. City , .4.r.1 A i t
TYPE OF U HAZARD The conditions noted below constitute an immediate hazard and may result in property damage,personal injury,or loss
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 eauipment until it has been repaired.
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Equipment Type: Location:n A r r t At*: j ''''''f•.<5 ( If .a x, i r
CONDITIONS ❑ 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 qq
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j / /Al i j +`Air f<.2.1 7" `1-,0)F ...
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Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. ❑ Owner Tenant ❑ Agent
Customer Signature ❑ Refused to Sign
t / ,,‹. -- Date 7 /" r_') r-fr
, Time am/pm
Service Representative'
White Copy—Customer Yellow Copy—Attach to Service Order Pink Copy—Authority Having Jurisdiction HardCopy—Appliance
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