79 Boston Street 1st Floor Complaint 9-11-2019 r�StiWT�
CITY OF SALEM, MASSACHUSETTS
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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
Date: Time: Received By:
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Complaint Number: 2567
Complainant
Address: 4Phone: 6/
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Investigated By: __ Date: _
Property Owner/Occupant Name _ _ _Telephone#:
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