This re copy is provided a a courtesy by Jack Jaffa & Associates Rat Estare Consuurasts emo Noa xo mean NOV# 4 1253260Z genera tM ee masrez =e ol eo Bie ROLE pen) np som ton ATT TE a QU LL Lie La 1 ‘ie of Wotan ara Girt ry Cora RE Nore ha arsine s hci tga re OREO PCOS NE nr ats separ os ty Swe rea on reteset ppey ean eran nl ved 2 an pany Aloe acai See a cee ei tn es tt mc et ma 9 star Soe sare earn ae ee eee ee ef fn =o [ROCAT OFFERONES WS SPPEAR te etng onesie, | emrraunim nana ania rma eae tna one nce nna a ree paat yf et ———— = 0 rT pslankaavoviinarionelan. m, 7 = eee a Yeoman OL vee a o vers e s vow Oo” ven ia 5 — ge ene Se rasa Fiore ioevccrewcmoran) itd eredeat cg) ee eee (2 sion anes nssecions vsti te NVI SN S oe Sa AFFIDAVIT (CERTIFICATE) OF SERVICE (COMPLETE REVERSE SIDE) Eee COPY Tack Jaf & Asocater nova verament agency and doce noe represent «goverment agency any form or manneThis re copy is provided a a courtesy by Jack Jaffa & Associates Rat Estare Consuurasts stAteoF NEw yan, cout oF The underighed being dl Shoe, over eiphieeg 68) yeas. of age at on 1 [adres 1. tnd Respondent by delivering ute copy to (inset names] __. eee AE thf te respondent 2 Partnership Respondent cob delivering a re copy 1 inset name: who isthe fins positon: oi Vere ot id respondent Corporate Respondent sles ‘of said respondent. ed of Violation and Hearing A. Laitempted to personally serve the stached Notice of Violation and He ‘espondeat sumed hein bt was unable odo so because, ving entered the premise and ving, ‘dented mpl Snr beveER Sppelez deen) that an appropriate rere respondent ws no presen 3. umble to secure iden of he person(s) present 4D advised by fase ame’ mur no fice, decor, mnnging agen, agent of pater of respondent prinerhilcorpomtion was presen [Te fotiowing is o be completed ia person was served withthe Navce of Violin an Hes Description of Invi. Deponen describes the individual served a follows OMale White Skin’ aback Hay OFemale aback Skin @Brown HEA fBYelow Skin Blond Hair decd Sino Brows Skin OGray Hair 051-65 ys 161-200 ibs, GREE Skin GWhite Hair Over 65 yrs Over 200 SBalaing Oter ideniying characterise Signa: Tack Jaf & Asocater nova verament agency and doce noe represent «goverment agency any form or manneThis re copy is provided a a courtesy by Jack Jaffa & Associates Rat Estare Consuurasts FP unit @IS) Admin co. LEICLZIS ENVIRONMENTAL CONTROL BORD NOTICE oF vOLATION R OZ mY OF NEW YORK SID HeARING alé lol) ‘SUPPLEMENTAL INFORMATION FORM Instructions: 1. Be sure to fil in the Violation Number at the top ofthis form and complete all of the information at the bottom of the form, 2. Indicate in the Description of Violation section of the Notice of Violation that a"Supplemental information Form” is attached. 3, The original (white) copy ofthis form shall be attached to the Notice of Violation, and the other copies distributed as indicated below. Violation Category | Supplemental Information | personally observed the commission ofthe above offense(s) or pereonaly reviewed the office Al statements made herein are affirmed under penatty of perury. inspector's wenieaton Number LUIMISIGIAISIS) sre (10-35 Codes (910) ECB COPY Tack Jaf & Asocater nova verament agency and doce noe represent «goverment agency any form or manne