Ye Olde Pepper Co. Complaint 4-25-2018 a
CITY OF SALEM,MASSACHUSETTS
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 LRAMDIN1'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: Received By:
Complaint Number: 2095
Complainant
Address: � hone:
Investigated By: _ Date:
Property Owner/Occupant Name_ Telephone #: