3 SKERRY STREET - TRASH COMPLAINT (2) 01"M
CITY OF SALEM,MASSACHUSETTS
' 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 LRAMDINCd'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: r Time: �! Received By:
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Complaint Number: 2162
Complainant
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Address: Phone:
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Investigated By: - Date: _
Property Owner/Occupant Name - Telephone #: