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COPuIPL,11Nioo�NVESTiGATION FORM <br />Date Complaint Received t= QR, 5� iq-14 <br />Received From FP_e.Lk 3 r-1r-ti _'-T <br />Address 3rV >K`S <br />Tele No. <br />NATURE OF rOMPLAINT - ir.--k <br />Date of Inspection . '_ I � -1q- <br />VIOLATIONS NOTED <br />r. i--4 1� j <br />Owner/Tenant Name <br />Address <br />ACTION TAKEN <br />RF6(NsKS <br />Follow-up laic <br />1%` L 1 <br />Inspcciors Signature <br />iL <br />