1994, 09-03 Warning NoticeFORM FURNISHED BY INLAND NORTHWEST HVAC ASSOCIATION.
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301 (6/92)
ADDRESS
PHONE NO.
CUSTOMER NAME
CUSTOMER SIGNATURE
OWNER ❑
AGENT ❑
PRINT NAME
ADDRESS
TYPE NOTIFICATION
❑ HAZARD
CONDITION TO BE CORRECTED AS SHOWN BELOW CREATES AN IMMEDIATE HAZARD. THIS EQUIPMENT
MUST NOT BE PUT BACK IN SERVICE UNTIL REPAIRS AND A THOROUGH INSPECTION HAVE BEEN
MADE. ISSUER'S PHONE NO.
❑" WARNING
CONDITION TO BE CORRECTED AS SHOWN BELOW IS NOT IN ACCORDANCE WITH SAFETY STANDARDS
AND COULD CREATE A HAZARD. CORRECTIONS AND A THOROUGH INSPECTION MUST BE MADE
WITHIN TWO WEEKS. ISSUER'S PHONE NO
CONDITION TO BE CORRECTED:
TAGGED BY COMPANY _ _
INITIAL _
TIME
DATE
REPAIRED BY COMPANY
INITIAL
TIME
DATE
CONDITION CORRECTED YES 0 NO 0
INTALLED HAZARD TAG
YES 0
NO ❑
COPIES SENT TO; (1) CUSTOMER (2) ISSUER (3) AUTHORITY HAVING JURISDICTION (4) EQUIPMENT TAG
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