Complaint y
N SALEM FIRE DEPARTMENT
IN-SERVICE' INSPECTION COMPLAINT
RECO MMENDATION
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! Date . ..:..:................ 19.....
Name...`.-......................................... ......::�.°~�:.'tf..`'- � �
Address...... .5....... < -
As a result of an inspection this date of the premises owned, and/or occupied by you, the following
recommendations are submitted which .should receive serious consideration. These recommendations are made in
the interest of fire prevention and to correct conditions that are or may.become dangerous as a fire hazard, may be
required,for legal occupancy/of the premises or otherwise are in violation of the claw.
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Reinspection date: ......................................................................
Form 2 D (Rev. 1/79) � \ ....................Inspector
(Fire Deptef -GOPT} . — f
In-Service Re-Inspection Report: Date: 17/G--��
Conditions found to exist at• time. of -Re-Inspection:
Name of person with whom recommendation follow-up was discussed.
Reasons, if any,- ,for failure to ,comply with_ 'original: recommendation.
Complaint has been corrected.
Forward this form to Fire Prev. Bureau for follow-up.
Eng. Co.
Inspector