Fairmount Street Complaint 8-27-2018 a
CITY OF SALEM,MASSACHUSETT'S
13OARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/RF.HS,CHO,CP-FS LRAMDIN(a,SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 78 '1 Time: Received By: _
Complaint Number: 2238
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Address: C2 l r`YU�I� Phone:
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone