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(Page ?)g <br />3 <br />INSPECTION DATE:_ Icl ~71 ~{~ INSPECTOR'S INITIALS: "`7 <br />OBSERVATIONS <br />~, Ii~:~ t,~~s~e~ar ~l~v.@ca~nv~~,.opsc~, ~'ic p~ruer c~ ct,K~.~~~ ~ ct~~~11~' <br />~u{I~~~~ ,IL?~~t-~;ct~.~ i,~9 1t~&~ ' ~lLl rr 61CP ~~~4.1 ~~ 1t~c 1,61 ~I'1lCl <br />nn;n ~%t uvt,~xbu,Q.~~i t~a,ti~l.-ti+~v r~Q ~u`~~ca,~~ Zx[.u.G,;.fi~~>a.~~,~,,L~ox~-, <br />~~i (`~.~r{ U~~lu~t'~0~ ~?i4~~~14G1~ c~unl- ~~I~LI~~C~ (,~~iellu,ruirzl <br />E'/. ~ f1@ L~ `L~C~I,~ ~~G U.'~CZ~ ltil IG1tia-~~""~l Z71.lJ.L~~ <br />C%t~~tt ~Nn ~ r~ Q ~u,~.~tuCP W~P~~LU ~ <br />I & E Contact Address <br />NAME:_ G' cc: ^ CE <br /> <br />OPERATOR: ^ <br />^ BL <br />FS <br /> <br />STREET: Q ^ <br />^ HW <br />Hh1WMD (CH) <br /> ^ SE <br />CITY/STATElZIP: ^ WQCD (CH) <br /> ^ OTHER <br />