Federal Court Complaint 8-1-2019 �y a
CITY OF SALEM, MASSACHUSETTS
aa: BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,41y FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(CWSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: ID �2,S _ Received By:
Complaint Number: 2517
Complainant
Address: Phone:(aj l' Jo? 'l" ! adl
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: _