2 BALCOMB STREET - TRASH COMPLAINT ^unwrq
CITY OF SALEM, MASSACHUSETTS
a BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
} FAx(978)745-0343
,�J� LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2251
Complainant
Address: Phone: _
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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