8 Lawrence Street Complaint 1-2-2019 h64 �.
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rF 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 LRAMDINf&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: { Received By:
Complai t Number: 2329 l
Complainant
Address: Phone:v,& t
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: