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SNOHCiMISN HEALTH DISTRICT <br />Court House <br />Everett, N:ashington '� <br />COMPLAINT SHEET <br />/�- --- <br />The Following must be completed t� (J�.; Date JO �%y'1 � <br />Name of Person causing <br />alleged complaint <br />Address or direcfions \ � � �3 ' <br />Nafure of alleged complaint <br />Nome of Person Reporting (Pleasc sign) <br />� � Y�(r S % <br />s� � .�,-�o-z� <br />1 e' f�n,� i'a�C�' /Y��. <br />/ <br />Address nwnc <br />[*f'.�RMhf��ttttltRRx}RM*1kR��kfklr*#4Ytfwti#f+1#V4kfw�R'k�lifR�f�Rf�lilrYrR�#RRffMfll�Rtk��1' <br />DU N07 N'RITE BFLVk' rH15 LINE <br />#ki.klkl*lkkR4irfi�f�R��.li�.l+h#*fA**#kfiiif��k**f*R1�k}Rk*MA�R�1r*fMMtti*��tiiitRktt�Y#R1`kft#wi <br />--� � <br />Invesfigated by_� N!', ;��„ , , �r Q ,� Date�— ��j --' ��' <br />�\ � � <br />� ( 'i <br />Conditions found J � _ ,�_� :,s _ . __ .� ,� � .� � � - � �+ <br />s+�nv;r <br />Person (s) contacted <br />Aetion taken � <br />F,ev.7:671 <br />