392 Essex Street Apt. 15 Complaint 1-24-2019 CITY OF SALEM,MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TI;FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDrNA'AI.EM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: l Time: Received By: y
Complaint Number: 2338
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Complainant _
Address: Q/, C, � rrf-ate t� Phone:
Investigated By: _ Date: _
Property' Olviler/Occupant Name _Telephone #: