12.5 Daniels Street Apt. 1R Complaint 8-1-2019 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 LRAMDIN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: f Time: Received By: `
Complaint Number: 2520
Complainant
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Address: 2 ` ! Phone:Ap, �7r&w -6 �� 71
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AIM
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Property Owner/Occupant Name___ _ _ Telephone #: __