22 Charles Street Complaint 12-12-2018 �COhUlidd
t= , 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 LRAMDINCV),SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM (�
Date: Time: Received By:Jefcre +'
Complaint Number: 2321
Complainant �DCA Al 5�
Address: 2. 16 _S ��',rF. -�' Phone:*73i w71��iruz+ 6pv; qOA-Lade, �;tj� OVI 02�
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: