137 Complaint 2012 BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
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Date: YO/(a/12..-
Time: 3'-'5 D
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Type:
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NATURE OF COMPLAINT:
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Taken by: ( !Date of Inspection: k/&/2-0 r- I
Time: 3'.act
INSPECTOR'S REPORT: /.yni
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Total#of In siectio t Orders Issued
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Date of Final Inspection:Gpy,,, Notice of Compliance?: Nr.
Inspector Signature