2 Cabot Street Unit 1 Complaint 8-22-2018 CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
_ KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN SALEM.CO
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time:�,� ,Pv _ Received By: .
Complaint Number: 2234
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name __Telephone#: