2003, 05-06 Notice of Unsatisfactory Conditions �u vISTA
NOTICE OF UNSATISFACTORY CONDITIONS S-o308(1-99)
Utilities
Customer Name 'v - ' Phone Number
Address /' 6 City ( 2, .CYSUGI
TYPE OF ❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage,personal injury,or loss
NOTIFICATION: of life.The equipment has been turned off pending further inspection and repairs,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.
U WARNING The conditions noted below constitute a potential hazard. Although the condition does not present an immediate
threat to life or property,failure to correct the condition may lead to a hazardous condition. Please contact a qualified HVAC dealer,
contractor,or service agency to perform further inspections or to bring the equipment up to current safety standards.
Equipment Type: `"', 11E-
',()1vt� i(rfllt'c . Location: °Pal's. i 1J10.1 t2.C'
CONDITIONS ❑ Apparent cracked or restricted heat exchanger ❑ Inoperative safety system
FOUND: ❑ Spillage of exhaust at the draft hood after a ❑ Insufficient combustion/ventilation air
reasonable warm-up time ❑ Gas leak at gas equipment
❑ Damaged appliance connector ❑ Other , , too-,
-z
or disconnected vent
❑ Defective limit control ,
1,
❑ A gas leak in your house piping in the amount of CFH ` l `�•r, t
with all known appliances off
I have read, understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent
❑ Refused to Sign
Customer Signature � �v
Service Representative Date �O > Time am/pm
Equipment Disconnected? LI Yes ❑ No Equipment Tag Left? ❑ Yes ❑ No Authority Notification Required? ❑ Yes ❑ No
Equipment Left ❑ On ❑ Off Meter Left ❑ Off ❑ On
WhiteCopy—Customer Yellow Copy—Attach to Service Order Pink Copy—Authority Having Jurisdiction HardCopy—Appliance \`