2004, 09-13 Notice of Hazardous Conditions Auw
;Air VISTA' NOTICE OF HAZARDOUS CONDITIONS
S-0308(08-01)
Utilities
Customer Name c>/) I�"'!-f1 ( r2 ri Phone Number - / ' 7, " :•9 2 L( .. / / 1
Address :'"fr 'P'.,, P„ 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 eauipment until it has been repaired.
Equipment Type: it. Afee-7— Location: e----/,..:.; ',' 4": '*".4 .
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 equipmentOther
Meter Left ❑ Off 17 On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. Owner LI Tenant ❑ Agent
Customer Signature -4Z–.)7 ❑ Refused to Sign
Service Representative t4' 0 Date 1 ' t a_6) P Time `�0'/ 7..‹E/.pm
I .C)
White Copy-Customer Yellow Copy-Attach to Service Order Pink Copy-Authority Having Jurisdiction Hard Copy-Appliance