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<br />INSPECTIONDATE:_ ~'fI~JQ~( INSPECTOR'S INITIALS: JCS-
<br />OBSERVATIONS
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<br />"`'"'E' ~ ('~ ~"•~~((~~~~ a~~~ ~~~rn~.-U-r~,~y RETURN~~~~~~PT REOUESTEL"
<br />OPERATOR:_ l.V`rRtiPA ~ZL1l.~lf ^ BS
<br />STREET: 3CjZ ~~[,~,N Cj'~'. ^ HW
<br />Q,H~MWMD (CH)
<br />CITY/STATE/ZIP: SQ,LI ~ ~ ~ ~~(~jz fa" WQCD (CH)
<br />^ OTHER
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