8.5 Herbert Street Complaint 4-19-2018 a
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,CF-FS LRAMDIN@SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: —9Time: I7 ; Received By:
Complaint Number: 2088
Complainant
Address: Phone:
77-9- VAX
"2 )91
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: