2003, 12-25 Permit: BLD-03-03160 Notice of Haz. ConditionsiuVISTA
Utilities
Customer Name
Address
TYPE OF
NOTIFICATION:
Equipment Type:
¢ CONDITIONS
4 FOUND:
NOTICE OF HAZARDOUS CONDITIONS
• 1 / 2 1�• Phone Number / 2 ' (1)
. ?Q e`t." / f r LE /"LC- pl.(G= - City ??V` ..
-iiAZARD 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 eauioment until it has been repaired.
S-0308 (08-01)
rj �1,�. "]�; Location• r'� tc—It..- _,,`4C -`'C -t.
[3 Apparent cracked'or restricted heat exchanger I:1A gas leak in your house piping in the amount of
❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment Other
CFH
t},
lam'`
44
Meter Left ❑ Off
0
Meter Number
I have read, understood and acknowledge re eiptof this notice.
Customer Signature,�"'�
Service Representative
1
White Copy — Customer
Meter Read
Owner ❑ Tenant ❑ Agent
❑ Refused to Sign
Date Z5.,-07 Time dr 0 am,pm
Yellow Copy — Attach to Service Order
Pink Copy— Authority Having Jurisdiction
Hard Copy—Appliance
,1
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