40 R Highland Avenue Complaint 7-26-2018 a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 'rime: ��- Received By:. garaf
Complaint Number: 2206
r
Complainant Atil L R
Address: ) ow^ ' Averi ut Phone:
v' er lR H tn L',d- A very r,le-IS
f I �
K[ + y
ef od-o Lz
Investigated By: Date:
Property Owner/Occupant Name Telephone #: