4 Lyme Street Complaint 11-9-2018 irk" CITY OF SALEM, MASSACHUSETTS
� � :
„,�? BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCgZSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM Date: Time: Received By:JeffrePCB✓n
Complaint Number: 2301
Complainant_ Lyrl —
Address: L.y hA � —Phone:
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Investigated By: _ _ Date:
Property Owner/Occupant Name__ Telephone#: