HomeMy WebLinkAbout2003, 05-17 Notice of Hazardous Conditions /IIS__
AridVISTA NOTICE OF HAZARDOUS CONDITIONS S-03°8(06-o,)
Utilities
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Customer Name Phone Number rr -
Address
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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
attemppt/t to use this equipment until it has been repaired.
Equipment Type: /` ' Location:
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 CIOther
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Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. d Owner ❑ Tenant ❑ Agent
Customer Signature •�' \ ' �j.�1' ❑ Refused to Sign
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Service Representative L, Date Date Time am/pm
White Copy—Customer Yellow Copy—Attach to Service Order Pink Copy—Authority Having Jurisdiction Hard copy—Appliance \ y'''CD