CE 390 5th St 2010 r
Compliance Investigation Form
Investigation#__R6 O Date of Request: t—/,I Time of Request:
Name of Person Making Request: �/Vrk—, 4.#—
Address:
rAddress: / o J S 4- Phone#
Investigation Type:
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Location (Address) of Violation: `//161p/ J'i"
Phone Number: PropertyOvaner/Manager: Pgfrna. Aro+ t'ascoe—
Request Taken by: Investigator:
Action Taken:
Compliance:
Legal Description: QS-06916RE#: l�O !`�.5o7-000t7
FACode Eofore mt\Compliance Investigation Fmm.dm Oa 9 2009