2004, 04-06 Notice of Hazardous Conditions 7
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A NOTICE OF HAZARDOUS CONDITIONS S-0308(08-01)
Utilities
Customer Name ,.. ',e,.'/. 1 , /i‘ ,)Ott,. 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: /44-7-4-7,,— !4:-Aire s f"i,./'/'/t/.i.ceitation: ` ,..460/1,1'iL ;�, f""-/.
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 p 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 Pu
Customer Signature 0' 5 l rc: ( ,41 c ❑ Refused to Sign
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Service Representative `C /t CDate G'"" ?' Time m
White Copy—Customer Yellow Copy—Attach to Service Order Pink Copy—Authority Having Jurisdiction HardCopy—Appliance