3 SKERRY STREET - TRASH COMPLAINT a
CITY OF SALEM,MASSACHUSETTS
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(SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
I C- I v
Date: l Time: I { Received By:
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Complaint Number: 2154
Complainant '
Address: 1 Phone:
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: