40R Highland Ave Apt. 506 Complaint 9-27-2019 CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLFY DRISCOLL 120 WASHINGTON STREET,C"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARK Y RAMDIN,RS/REHS,CHO,CP-FS- LRAMDIN(C).SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: 9 12-�-711QTime: _ i Received By: V- /?
Complaint Number: 2593
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Address: A `�- hone:���
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Investigated By: — _ --Date: --__--
Property Owner/Occupant Name Telephone #: _ — —