Gallows Hill Complaint 4-23-2018 CITY OF SALEM, MASSACHUSETTS
; .
BOARD OF HEALTH
_ KIMBERLEY DRISCOLL. 120 WASHINGTON STREET,41H FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINRSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: #_i Received By:
Complaint Number: 2093_
Complainant JJL
Address: Phone: � -
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Investigated By: Date:
Property Owner/Occupant Name _ Telephone #: