24 Walter Street Complaint 6-1-2018 CITY OF SALEM MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLI. 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr01SALEM.00M
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2137
Complainant
Address: �,1� � �i Phone: <0 q/7 . �
Investigated By: Date: _
Property Owner/Occupant Name- Telephone #: