10 Hathorne Street Complaint 5-16-2018 a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,eH 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: Time: '' : F Received By: "
Complaint Number: 2125
Complainant
Address: Phone:- /``t
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Investigated By: Date: _
Property Owner/Occupant Name_ Telephone #: