414 Loring Avenue Complaint 5-24-2018 CITY OF SALEM,MASSACHUSETTS
w. BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(91SALEM.COLvt
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: � Received By: ,
Complaint Number: 2130
Complainant L�A= _
Address: 4/4— Phone:
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Investigated By: _ Date:
Property Owner/Occupant Name_ Telephone#: _