19 Chandler Street Complaint 5-13-2019 a CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDTN,RS/REHS,CHO,CP-FS LRAMDTNCa�1SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: jJ Received By:
Complaint Number: 2435
Complainant _
Address: Phone: q�Q y Y71 1 qg
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Investigated By: _ — _ Date: _
Property Owner/Occupant Name Telephone #: _