Skerry Street Complaint 2-7-2019 e* urra•
((hn s 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 LRAMD1Ngg SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: _ Time: I�,' Received By: V _
Complaint Number: 2349
Complainant t _
Address: Phone:
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Investigated By: _ Date: _-
Property Owner/Occupant Name _Telephone #: _ ___