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<br />INSPECTION DATE: ~ a"F~-c'CJ INSPECTOR'S INITIALS: J
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<br />I & E Contact Address
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<br />NAME: I,JI>({,~ LC7/J~ ~ 434 ~f4 I (OZ~
<br />OPERATOR:,(~A,'7771~ Mo4e~17A-ltr 75 PSOtlF1C.e.$i «1C
<br />STREET: ~ E! ~~Y/ ~ In
<br />CITY/STATE2IP: ~OJ L.LilS~ ~ ~~ISoZ
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