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0 <br />COfJ�PLAuVT INVFSTIGATION fORP,9 <br />Date Complaint Received /� ���Q 73 <br />Received From Mr`S /i�Z/'��'1/ "CCcN�'R <br />Address � l'� S '���'+ n i T <br />Tele �o. .Z S2- y`/G / <br />' NATUR� OF CG'.'PLAINT �(7�2 K'A/�R�S �n./ `-' <br />.l��aa�E- ac ,.�G D�,o�,s� . �t/oT,�,.� � <br />/�e7 iG Do�v� %v2 `v�i� �o.vT�iS <br />, <br />Date of Inspection �/ ��� � �� <br />VIOI.ATIONS t�1�TED <br />c.h,,�,,a-,-n C;Ar. at_,:- o..� <br />Owner/Tenant Name <br />Address <br />� <br />0 <br />ACTION TAKEv <br />� . !_, __ - %ii: , �.• . i . \i <br />—" v <br />� ..�>> <br />(;'� /'' r;, �i�jt(�<i 'i?-jr ;�.r';.;,Cv n( <br />REh1ARKS <br />n1�-� lc_��inE' ��:;,r,�., �� ��� �'• <br />i <br />y-�� -�3 c�R�L� �� ..-,���� ; <br />Follow-up date <br />/ <br />Inspectors Sipnature <br />