2003, 04-29 Notice of Hazardous Conditions "17—
�iliVISTA®
NOTICE OF HAZARDOUS CONDITIONS s-0308(06-01)
Utilities
1 G� ,,� V 3 33
,, Customer Name /I:Phone Numberit
/
Address City -7 6 1
i 2O(s2 —54.3e-)
TYPE OF U HAZARD The conditions noted below constitute an immediate hazard and may result in property damage,personal injury,or loss
ti NOTIFICATION: of life.The equipment has been disconnected or left inoperable,and shall not be turned back on until such repairs have been completed
d 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: Location: '` 'C^ 4'4.'
CONDITIONS ❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of CFH
t. FOUND: ❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment ❑ Other
1 Ili
Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent
Customer Signature ,�yJ ��,� ❑ Refused to Sign
Service Representative %'� 1' / � %'"y`'e ' Date - Time am/pm
White Copy—Customer Yellow Copy—Attach to Service Order Pink Copy—Authority Having Jurisdiction Hard Copy—Appliance --.)