West Avenue and West Circle Complaint 5-24-2018 CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDTN&ALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: . Time: �y✓ Received By:
Complaint Number: 2134
Complainant
Address: hone:
1
Investigated By: Date:
Property Owner/Occupant Name Telephone #: