6 St. Paul Street Complaint 5-31-2019 a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLI, 120 WASHINGTON STREET,41H FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDrN[aDSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: ys Received By` G
Complaint Number: 2450
Complainant 1
Address: Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: