3 MASON STREET - TRASH COMPLAINT n CITY OF SALEM, MASSACHUSETTS
„F BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4" 'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN a.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ! Time: _ _ Received By: _
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Complaint Number: 2191
Complainant
Address: ? �7�/�� 1�'� � — Phone:
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Investigated By: Date:
Property Owner/Occupant Name _ Telephone #:
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