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<br />INSPECTION DATE ~/~/ ~~I~ INSPECTOR'S INZTIALS~
<br />OBSERVATIONS
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<br />I ~ E contannct AddrJess / / JJ cc: ^ CE - /3er~. (rCe{~Q%,,,/
<br />NAME /yl/~• b'a'hn l~r~R. ^ BL
<br />r`~'> ^ FS
<br />G~J~- c-~c~X~ I / TU7 `6lo'~aE ~o , ^ HW
<br />OPERATOR N ~' ~~ ^ HMWbQI (CH)
<br />STREET r r ~ O , ~d0)<` ~°1 ~ ^ SE
<br />^ WQCD (CH)
<br />/(c~ CQ SO ~C~ CJ ^ OTHER
<br />CITY/STATE/ZIP i
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