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I� _ _ <br />�I� <br /> li <br />�i <br />� d <br /> CGI;iPLAIf1T INV�3TI.GAT�G'! f0�i':9 <br /> Date Complaint Received `" /'�/'9`/ 197� <br /> Received From ��G� �• C• ����'Mlty <br /> Addre:,s Z sv Z '� C�'/��✓Q �V6 <br /> Tele No. 2 5 z —Z 3 -s y <br /> NATURE OF (bPd,PLAI NT �u.rd; AT -� S� S c As j �/[o�.�` _ <br /> F,2� f/n�R2 D , f�� ���Fs F�c H��•� G. ,� _ �oa�rr <br /> �� . <br /> � A �-C. i nrG o FF j 4A-r ff ,� �Te . _ - <br /> � <br /> Date of Inspection /�� �� <br /> VIOLATIONS (�TED <br /> p/}n.�N2u✓S �X /��C'o.�,�i I��Kct,� ) <br /> _ � <br /> — � <br /> Ownn.r/T.� Name L� r? R y �s��/�.�c � i � <br /> Address �y3% Cf/-p J n.�v 1 2S'.�-7450 : , -�� ,,--�- � <br /> l: '�� ��U v r� � � ' j�, , < / �. r -�- �.1 <br /> ACTION TAf(FN <br /> — �c � , . � <br /> i c_ �-� � <br /> � <br /> � ' <br /> � <br /> ai <br /> �� <br /> HFII:IRI<S <br /> Follow-up d�tc ___ _____ <br /> � , <br /> , In�pectors Sign�ture <br /> � <br />