22 Bridge Street Apt. 1L Complaint 6-4-2018 rwr
CITY OF SALEM, MASSACHUSETTS
Rp.
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 LRAMDTNQSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ) / Time: Received By: Vk
Complaint Number: 2138
Complainant. &M,46�
Address: Phone:
hivestigated By: _Date: _
Property Owner/Occupant Name Telephone #: