2003, 05-12 Notice of Hazardous Conditionsuril7STA
Utilities; NOTICE OF HAZARDOUS CONDITIONS
Customer Name bvti �... Lac ,.li:- Phone Number
Address /0 l ) 6 City
TYPE OF
NOTIFICATION:
Equipment Type:
X27- Q.5100
S-0308 (06.01)
0 HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
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.
.) J /"i'} rL C 1 /L./" () L /• Location. of JC7,1,1- Nr"
CONDITIONS ❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of
FOUND: ❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent ❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment ❑ Other
CFH
`.41 664 4,1k; 2 ...5" ` LSA f; 2ftj'r l c.
Meter Left ❑ Off ❑ On Meter Number Meter Read [.
I have read, understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent
Customer Signaturef. r� ❑ Refused to Sign
Service Representative ..10.577.4 Date '�) " r' Z ' Time / ()‘3
� am/fm j
White Copy -Customer Yellow Copy -Attach to Service order Pink Copy-AuthorityHavingJurisdiction Hard Copy- Appliance
AAtigISTA
Utilities �
.//
Customer Name
Address -
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
NOTICE OF HAZARDOUS CONDITIONS
"4.; U o'Ar'ci �4.- Phone Number J2'/ _ %c .2;72
/O 7/ -47:- City Po
5-0308 (06-01)
❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
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 equip m nt until it has been repaired.
-) s Y- /iLG 4 C
• Apparent cracked or restricted heat exchanger
❑ Damaged appliance connector
• Damaged or disconnected vent
O Gas leak at gas equipment
Location- rtJ/N'
O A gas leak in your house piping in the amount of CFH
with all known appliances off
O Insufficient combustion/ventilation air
10 Other
r4.5 iwA.:: - K. I it 0 t.{ N .I) .J Y vt- I Q AJ l .0 Airy
"11(t 5'1_ t- '7-241E- 0 ?L. J -4) k 4 C 47- �< /ry _
Meter Left ❑ Off ❑ On Meter Number Meter Read
I have read, understood and acknowledge receipt of this notice. 3 Owner 0 Tenant ❑ Agent
Customer Signature 0 Refused to Sign
Service Representative--/I///I & r4J• Date /Z '0 Time
White Copy- Customer Yellow Copy- Attach to Service Order
Pink Copy- Authority Having Jurisdiction Hard Copy -Appliance
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