23 Gallows Hill Road Complaint 8-1-2018 C TY OF SALE ASSACHUSETTS
' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: _ Time: Received By: 'y17 f
Complaint Number: 2214
Complainant
y,
Address: Phone:
Investigated By: _ _ Date:
Property Owner/Occupant Name _ __� Telephone #: