143 Canal Street Complaint 5-16-2018 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 LRAMDINr&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: / Time: Received By:
Complaint Number: 2124
Complainant
Address: / Phone1 '-26C�,,A 5�L 9�Z
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