12 Monroe Road Complaint 7-29-2019 CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,f"FLOOR
MAYOR TEL.(978)'741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 01 Time: Received By: jdfa�ll L7
Complaint Number: 2513
Complainant
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Investigated By: _ _ Date: _v
Property Owner/Occupant Name- Telephone #: