2004, 03-04 Notice of Hazardous Conditions'4VISTA• NOTICE OF HAZARDOUS CONDITIONS
Utilities
$L308 (08-01)
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Customer Name Phone Number i-
Address ,� Ci K
TYPE OF result
HAZARD p Theconditionshas noted ct constitute pimmediate haard not be maydbac onunilpropesuch repairs
have
al been
ury, or loss
completed
NOTIFICATION: of li .The equipment has been disconnected or left inoperable, and shall notheturned 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 eouipme nt until it has been repaired
Equipment Type: %' �/ Location: k <lc_ -
CONDITIONS 0 Apparent cracked or restricted heat exchanger 0 A gas leak in your house piping in the amount of CFH
FOUND: 0 Damaged appliance connector with all known appliances off
0 Damaged or disconnected vent E3 Insufficient combustion/ventilation air
0 Gas leak at gas equipment Other
Meter Lek 0 Off jFilDn / Meter Number
I have read, understood and acknowledge receipt of this notice.
Customer Signature
Service Representative
0 Owner Tenant
❑ Refused to Sign
Tme
-`�
Date - < a m
0 Agent
worte Coy -Customer Yellow C*Y- Anachro Service Omer Pink Cap,- AwhoruY Having Junsdwmm Hard Cozy -Apnlience ) IV
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