2003, 11-19 Notice of Hazardous ConditionsHi VISTA
Utilities
Customer Name •� �' r
Address %%i7' )4' 6
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
7
NOTICE OF HAZARDOUS CONDITIONS
C
Phone Number
City
S-0308 (1 01)
i
HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
f ife. 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.
Eo1<<�
❑ Apparent cracked or restricted heat exchanger
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
Location
❑ A gas leak in your house piping in the amount of CFH
with all known appliances off
❑ Insufficient combustion/ventilation air
O Other
-71
Ve//2.,
Meter Left ❑ Off ❑ On Meter Number d Meter Read
I have read, understood and cknowledge receipt of this notice. Owner ❑ Tenant ❑ Agent
•r j
Customer Signature
r y �---.�
Service Representative
Date
0 Refused to Sign
/In/ 6
Time
White Copy - Customer Yellow Copy Attach to Service Order Pink Copy - Authority Having Jurisdiction Hard Copy - Appliance
.(7/arQ1,_
.s
•PLUS - Permits land llse System z..:.
E. Site
eneevernan 04,91
SNe Name]
:I Inspector District IF JJ Go To Site Number. 8217E
law IeiItlaICmnpimceIimagetIOtte 1
I Nbr Db Name
,1W7 011406 E J47TH
St Crary 71p Cale
WAJUSA JW006
Type Al
AVEJ
_ l SCONE
GROSSMAN, S &M
11406E 41T11 CRT
SPOKANE, WA 992019469
EMa9
Occupant
Phone (609)00S-0001
FA&
DOD:
lst l/il of 1
Monday, Dec 15, 2003 03:11 PM