80 Washington Square Complaint 5-24-2018 a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERL.EY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINASALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2131
Complainant APP221 LL6
1,4
Address: 6hone:
OC
Investigated By: Date:
Property Owner/Occupant Name Telephone #: