2004, 10-28 Notice of Unsatisfactory Conditions �IilVISTA
NOTICE OF UNSATISFACTORY CONDITIONS S-0308(1-99)
Utilities
Customer Name Phone Number
•
Address 4-/L.,, ,,,/ ,- ( City ,
WE-
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TYPE OF U 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.
❑ 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.
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Equipment Type: Location:
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
❑ Damaged or disconnected vent
❑ Defective limit control
❑ A gas leak in your house piping in the amount of CFH
with all known appliances off
I have read, understood and acknowledge receipt of tis notice. ❑ Owner ❑ Tenant ❑ Agent
Customer Signature r'~ = �` f` r ❑ Refused to Sign
Service Representative ,, C.-- Date •- '1 Time am/pm)
Equipment Disconnected? ❑ 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 Hard Copy—Appliance