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,.-, <br />cc�:cPLAI t!T I P!VESTI GATIOP! roRrn <br />C.�te Con�plaini Feceived �'f�"ti^ � �( 7 (/ <br />Received From <br />Address <br />Tele No. <br />NATURE OF COMFLAINT <br />�MJ,vY Ht o US <br />J�,v/� L,�.�-,� e� nT S9io <br />LD,.-, ��-2 i� f1�c_ Quic ��.,✓G �- s�h.— <br />t� ,�j Ho %��/L i'-� � j <br />Date of Inspection <br />VlOLATIOPIS P:OTED <br />nP Z � i .'j,.r 1 S 1 4� <br />�u�-wpA"ii. M I�.�f` SMA�.I, f3� ��t f�iti-1 iti-� RAcK. <br />Own�:r/Tenant Name <br />Address <br />ACTION TAKEN <br />M��,fz�� F�n�—t�. w•:,�.�5 4-��'�/'[Y- <br />r�E�ani�Ks <br />F� i ia��+-�f� d�t�: <br />x�u.c �. <br />L.,... ,�% L- - <br />Inspecturs Sipn�turc <br />