19 Circle Hill Road Complaint 5-31-2018 'r Y 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 LRAMDK SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date!' Time: Received By:
Complaint Number: 2136
Complainant �� P.A /y/--
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Address: Phone:
AL
Investigated By: _ _ Date:
Property Owner/Occupant Name_ Telephone#: