39 Complaint Record 2011 tAk-ne E.y Kk-nf M`Y�
BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Date: 2It!!/
I Time: 11: S 0
I GEO: ✓
TYpeAtSond
n
Name of o1ll/nnpiainant: /curia T(i.s
0.h
Addres • <.
Tel:S 7-6807
R3 ma.. S
,,,,,�,,,
- rUIL
— I c
(,�nSU�
//
/.
h
NATURE OF COMPLAINT:
i3 o.■ 14
drOnp ,�1� /
1( /I yr C6finnc-uim.P
�.rrt b�..
Roo(i 0C bUi ��•�a/
.ti yl}/It 1u16F 0(f //.1
aU j I Lb (f L
Location:
Owner: tf$a OVAL( i)Evf-.� Nt f Ft - (0✓w5 %
,
Address:
J
Tel:
3°f MAI >7
,
&/7'
Time: 4:C Op...�
Taken by. I Date of Inspection:
1
INSPECTOR'S REPORT:
D05 r JO;�n- ^ 9-n '1-c Gee c.'.ucs r.✓S
ce)A"S 3Lc1.3'Nb O + F= Dr S7rM e JP .
/4/2 e0.1- Ca , L I_ C=I- ER..'1
Check m If YES I
Total#of Inspections: I Orders Issued?: N 0
Date of Final Inspection: S/Y Notice of Compliance?: t!a
0
Inspector Signature