43 Summit Avenue Complaint 6-21-2018 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 LRAMDINlalsALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: �� Received By: /
Complaint Number: 2163
Complainant f
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #-.