2004, 05-29 Permit: M80-9577u�i'/STA'
Utilities
Customer Name
Address
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
f
efi 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 completOd
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.
NOTICE OF HAZARDOUS CONDITIONS
'72 2 - / �i?'
Phone Number
City
S-0308 (08-01)
Location:
❑ Apparent cracked or restricted heat exchanger 0 A gas leak in your house piping in the amount of CFH
U Damaged appliance connector�With all known appliances off
❑ Damaged or disconnected vent-LY,Insufficient combustion/ventilation air
❑ Gas leak at gas equipment ca:- Other
Meter Left ❑ Off 0 On Meter Number Meter Read
I have read, understood and acknowledge receipt of this notice. . 'l, Owner 0 Tenant 0 Agent
Customer Signature 0 Refused to Sign
Service Representative Date Time
WhiteCopy- Customer yellow Copy - Attach to Service Order Pink Copy - Authority Having Jurisdiction Hard Copy - Appliance
; ?O ark/pm
Utilities
Customer Name
( /2122
Address
,,/ NOTICE OF HAZARDOUS CONDITIONS
TYPE OF
NOTIFICATION:
Equipment Type:
ONDITIONS
FOUND:
Phone Number 92e -IR
City
S-0308 (08-01)
.'1J -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
attempt to use this eauioment until it has been repaired.
❑ Apparent cracked or restricted heat exchanger
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
Location.
•
❑ A gas leak in your house piping in the amount of CFH
with all known appliances off
❑ Insufficient combustion/ventilation air
❑ Other
Meter Left ❑ Off - On Meter Number
I have read, understood and a knowledge receipt of this notice.
L'2/�J , 1/1,41
Customer Signature
Service Representative
Meter Read
^'C]� Owner ❑ Tenant
White Copy- Customer Yellow Copy - Attach to Service Order
Date
❑ Agent
❑ Refused to Sign
Time
(9--0
Pink Copy- Authority Having Jurisdiction Hard Copy - Appliance
II�VISTA'
Utilities
Customer Name
Address
TYPE OF
NOTIFICATION:
NOTICE OF HAZARDOUS CONDITIONS
Phone Number
City
S-0308 (08-01)
z P -y3 /8
7.2
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
attempt to use this equipment until it has been repaired.
Equipment Type:
CONDITIONS
FOUND:
Location: c e
❑ Apparent cracked or restricted heat exchanger ❑ A 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
Meter Left ❑ Off ❑ On Meter Number
I have read, understood and acknowledge receipt of this notice.
Customer Signature J
Service Representative
/iv/1
Meter Read
0 Owner ❑ Tenant ❑ Agent
❑ Refused to Sign
Date
White Copy - Customer Yellow Copy - Attach to Service Order Pink Copy - Authority Having Jurisdiction
a\\''
Time' 2."7
Hard Copy - Appliance