297 Complaint 2010 Date
Name
Address:
NATURE OF COMPLAINT:
c- 29-1 Fi im...4 • WS I114-/ sil( /T
— 1%4u—a nfer;V\
`r?3 - c4 - qq6
Address•
Taken by:
Date of inspection:
Time:
INSPECTOR'S 7pEPORT:
J ' m ;Q ti,e_c , " P his c,n
-�✓v.1 oic25 VW\ 4c, ■ i- m ti F`f
��rr t �
C ( J r ni L- 'tc k✓ALvr ,
- 'Tqht -(,gyp D.14-2„A
,• �a.�W..,�> trri 0. rn
(. vi, GAi,rvu
fiction Taken:
nspector Signature
bi0nAk14.1kHnkn i )
g
O