505 Loring Avenue Complaint 9-18-2019 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
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Date Time:� �� Received By:
Complaint Number: 2577
Complainant
Address: Phone:
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Investigated By: _ _Date: _
Property Owner/Occupant Name— _Telephone#: —_