2004, 09-09 Notice of Hazardous Conditions A 7vISTA
NOTICE OF HAZARDOUS CONDITIONS S-0308(08-01)
Utilities q.
til f
Customer Name £ -^^' - Phone Number
Address ' City '(
TYPE OF D 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 Type: f iLocation: getsr/nriti
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
Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. U Owner ❑ Tenant ❑ Agent
Customer Signature /VAit, 4. ❑ Refused to Sign
f
Service Representative \/e,-. j)j{ VOV Date Time -. ,1
O`^' a /pm
WhiteCopy-Customer Yellow Copy-Attach to Service Order Pink Copy-Authority Having Jurisdiction HardCopy-Appliance . b'V°