2003, 11-18 Notice of Hazardous Conditions �uVISTA
NOTICE OF HAZARDOUS CONDITIONS S-0308(08-01)
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Customer Name ,,,„, Phone Number , ..91/ f"1/60
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Ad tress °� /,Z City
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 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
attemotto use this eauioment until it has been repaired.
Location: , l' / i. ..-�'`G/� L,
Equipment Type: /
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. ❑ Owner ❑ Tenant ❑ Agent
Customer SignatureG
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Service Representative . 'I r > it-,Date 03 Time am/pm
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iPt SPOKANE,WA 11316 E MONTGOMERY
GSSPOKANE,WA 99206 SPOKANE,WA 00000
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Monday,Dec 15,2003 03:07 PM