2004, 03-25 Notice of Hazardous Conditions =it VISTA'
• NOTICE OF HAZARDOUS CONDITIONS S-0308(08-01)
Utilities,,
Customer Name 8e,Y 4 e..A. V\ .(A' +�% ""k" Phone Number '177- (,/s3
Address I F ", City - ',
TYPE OF `
CI 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 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 T e: e t' t — (.�,-
Type: Location:
CONDITIONS ❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of CFH
FOUND: ❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment ❑ Other
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Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. I`❑ Owner ❑ Tenant ❑ Agent
Customer Signature t ❑ Refused to Sign
Service Representative 6 0 DateTime�= o,'"
White Copy-Customer Yellow Copy-Attach to Service Order Pink Copy-Authority Having Jurisdiction HardCopy-Appliance ���