9 Lincoln Road Complaint 9-16-2019 7
YCITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T}'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCwSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: ` Received By:
Complaint Number: 2573
Complainant Xzy7
Address: L Phone:
11 �
IL
Investigated By: _Date:
Property Owner/Occupant Name_T Telephone #: