9 Laurel Street Complaint 6-18-2018 J- 1dl ► �1=: �� P6�.'� bw-'� -a � � )��.
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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(4tSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: '� Received By: a �"
Complaint Number: 2156
Complainant 1
Address: ®► .C1 La.LrQf Phone:TQ)
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Investigated By: I _ _Date:
Property Owner/Occupant Name__ __ Telephone #: ^_ _