89 Ocean Avenue Complaint 8-31-2018 CITY OF SALEM, MASSACHUSETTS
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 LRAMDIN@SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: 'J1 Time: ` Received By: Y1�
Complaint Number: 2242
Complainant 21
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: