172 Complaint 2013 BOARD OF HEALTH ' C'r
CITY HALL 2°t3
COMPLAINT RECORD 0001E9
Date: q/t //-j Time: /:9z)
I GEO: I Type:
Name of Complainant: SELF:
Address: (3-C-E1 5 met "-E55 S i
Tel:
NATURE OF COMPLAINT:
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Location: / 71. AJ. ,/- r.JG 5i -E
Owner: c4yeE2.r C. BRKc , jid 04Z
Address: 1 Xv c).ti's :7`.'t-'..`5 'tiD
ITel: 9 r`/
Taken by:
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Date of Inspection:
INSPECTOR'S REPORT:
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I Time:
Total #of Inspections:
Date of Final Inspection:
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Inspector Signature
Orders Issued?:
Notice of Compliance?: n%D