10 Geneva Street Complaint 7-15-2019 v nwur,,�
' CITY OF SALEM, MASSACHUSET T S
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� ,,,,�.wr� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Ta FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMA D1N SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: _ _ Time: Received By.
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Complaint Number: 2493
Complainant Zn
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Address: /� � 2]�,�_� Phone:
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Investigated By �,1 Date: -----
Property Owner/Occupant Name Telephone #: __� -------
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