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i <br />CU'.TLr,lh. 11NVrSTIG.:TIO'•I FnP�9 <br />Date Complaint Received �� -J a lf2 y <br />Received From <br />Address <br />Tele No. — <br />NATURE OF C 'IFLAINT <br />i b <br />Date of Inspection 3 <br />VIOLATIONS NOTED <br />Owner/T_e Name /` U ✓ �� � p c <br />Address <br />ACTION TAKE^' <br />EMARKS <br />Follow-up date <br />2 <br />Inspectors Signature <br />`a <br />a <br />