2008, 07-22 Notice of Hazardous Conditions(VISTA
Utilities
Customer Name
Address 77
TYPE OF
NOTIFICATION:
NOTICE OF HAZARDOUS CONDITIONS
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Equipment Type:
CONDITIONS
FOUND:
Phone Number % C a' Y Z
City -&'7*-j / ' ),A ` •
S-0308(11.05)
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
Location.
1Cd. / (// A/'7 / <QO # )
attempt to use this eauii ment until it has been repaired.
❑ 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 CFH
with all known appliances off
Insufficient combustion/ventilation air
Other
f I i .l .I7
�•f '14 �� may.
Meter Left 0 Off ,. l On Meter Number
I have read, understood and acknowledge receipt of this notice.
Customer SignatureX
Service Represen
Meter Read
D` Owner ❑ Tenant ❑ Agent
❑ Refused to Sign
ative
Date
fnom.�.
White Copy— Customer Yellow Copy— Attach to Service Order
(y),
WMS #
Pink Copy — Authority Having Jurisdiction
Time /-5•Z/am/pm
Hard Copy—Appliance