7 North Pine Street Complaint 5-2-2018 =r, 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 LRAMDIN .SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: D2 f 2(j� Time s� Received By:
Complaint Number: 2098
Complainant i,
Address:_1 /� 1` �s Phone: -
Investigated By: _ Date:
Property Owner/Occupant Name _Telephone #: __