6 Gallows Hill Road Complaint 8-7-2019 a
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 LRAMDINZSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: 6,` % Received By:
Complaint Number: 2529
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Address: , Phone:2
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: