112 Rainbow Terrace #112 Complaint 7-18-2019 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 LRAMDrN(t�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: `t -19'lj q Time: �' 5 Received By:
Complaint Number: 2501
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Complainant . 1cf- �� Y
Address: _ RalobQu'.) L- Phone:c
Investigated By: _ Date: _
Property Owner/Occupant Name _Telephone#:
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