18 Forest Avenue Complaint 10-15-2018 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,CP-FS LRAMDINVz)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: / Time: _ Received By: f '
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Complaint Number: 2287
Complainant 4J9,11 ,
Address: Phone:
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Investigated By: —_ — Date:
Property Owner/Occupant Name _ Telephone #: , __