Complaint 2012 BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
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Date: 3/n/2 c(z-I-Time: UOrcCo-14T--IGEO:
'Type:
Name of Complainant: RJSSEtl
Address: r`(o.4b HOJS.nI(e 4°itO1try
Tel: 5-e0 -
302>co
NATURE OF COMPLAINT:
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Location:
Owner:
Address
Tel:
Taken by:
'Date of Inspection:
'Time:
INSPECTOR'S REPORT:
Digital phamm Tel.,I cheek Box'IVES
Total#of Inspections: Orders Issued?:
Date of Final Inspection: Notice of Compliance?:
0
Inspector Signature