32 Hazardous Material Report & Complaint REPORT ON A HAZARDOUS MATERIAL SPILL INCIDENT
DATE OF INCIDENT:#//90
LOCATION: aca Nita r14,(--1..., S r
REPORTED BY:
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DESCRIPTION OF INCIDENT:
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REPORT SUBMITTED BY:
Pete J. McErlain
Health Agent
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BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
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Date
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Time:c230
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I Typo: $3
Name of Complainant:
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Address: I Tel:
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NATURE OF COMPLAINT:
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Owner: -1?
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Address: t46,4P a gy ITel:
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Taken :
I Date of Inspection:
I Time
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Total#of Inspections: Orders Issued?: 9�
Date of Final Inspection: pApo z- Notice of Compliance?: Mfil
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Inspector Signature