62 Complaint 2012 BOARD OF HEALTH-
CITY HALL
COMPLAINT RECORD
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Date: (Q f(!/j y
I Time:
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Type:
Name of Complainant: A.L,eg,JaT'E.J'JN
Address: Vo}Gu o -: 1 ;c1...�,
Tel:
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NATURE OF COMPLAINT:
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Location:
Owner:
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Address: be o -i ki '�e p—i �
Tel:
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Taken by: 0 I Date of Inspection:
Time:
INSPECTOR'S REPORT:
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Total It of Inspections: mil/ Orders Issued?: Q0
Date of Final Inspection: (pi ttalL ,Notice of Compliance?: J
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Inspector Signature