2003, 11-06 Notice of Hazardous Conditions „ow
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:- VISTA'Utilities NOTICE OF HAZARDOUS CONDITIONS S-0308(08-01)
Customer Name _ Phone Number l q1 �
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Address f �/ •
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
attempt to use this equipment until it has been repaired.
Equipment Type: '� Location: i'---V,74 0-
CONDITIONS 0 Apparent cracked or restricted heat exchanger 0 A gas leak in your house piping in the amount of CFH
FOUND: 0 Damaged appliance connector with all known appliances off
0 Damaged or disconnected vent U 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. ❑ Owner ❑ Tenant ❑ Agent
Customer Signaturer t ❑ Refused to Sign
1 - DatePm
Service Representative /6/ ' Time �°•� a�
White Copy—Customer Yellow Copy—Attach to Service Order Pink Copy—Authority Having Jurisdiction Hard Copy—Appliance . \\°