Complaint Record 2016 fr
Ceo Tray=Idle =.
CPSYs Rl
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srs
Entered By:(, B<-Slo p
FOOD FOOD ILLNESS
ODOR PESTS
WATER/SE TR HOARDING
C0\-LpLA[NTA_'TT'S fNFORM14ATtON:
Date Entered: q)/CAI
H OLI SNO
POOLS
NAIL SALONS
SEPTIC
OTHER
CarE Taker InitEaEs:CP R
Date of Complain'. ; i t L
'omplautant's Name Daniel Mi Redo K
S(1_,n C
:ctplaintLocztion: C l` OCE. e
)ccupant's Name:
uATERE GE
:O NfPLAINT:
kalI Li.) mys e-4 salvo lcoSe
Telephone: ht 13)7Z7-3-32-(,
Telephone = (
Animals:
Child Under 6: Y-N
Z.-a ae disC (bit di1-;efili L.
) NER'S INFORMATION:
A)e, tl n-1e n Address:
Ao7C;Ira AJtLafT lY Address: Alternate
//e/ dtAbel g/l9 Ai 747 c45 c-a3:5
hi'ner's Name:
'ropemy Mgr.'
and Lord:
nspection
scheduled on:
:omplaint
'mounded:
londitions
'ound:
Telephoner( )S u4_1_Z:
SCTION TAKEN:
!immure of Inspecting Officer
Date.Tine of Inspection