2003, 05-03 Notice of Hazardous ConditionsAimi VISTA°
Utilities NOTICE OF HAZARDOUS CONDITIONS
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Customer Name
Address
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
S-0308(06-01)
❑ 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.
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Apparent cracked or restricted heat exchanger /!
0 Damaged appliance connector g A gas leak in your house piping in the amount of CFH
0 Damaged or disconnected vent with all known appliances off
U
CI Gas leak at gas equipment Insufficient combustion/ventilation air
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Meter Left 0 Off 0 On Meter Number Meter Read
I have read, understood and acknowledge receipt of this notice. 0 Owner 0 Tenant ❑ Agent
Customer Signature
0 Refused to Sign
Service Representative
•
White Copy -Customer Yellow Copy- Attach to Service Order
Date
Time am/pm
Pink Copy- Authority Having Jurisdiction Hard Copy -Appliance