4 BELLEVIEW AVENUE - TRASH COMPLAINT A CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
TEL.(978)741-1800
F MAYOR FAX(978)745-0343
1
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN ei cALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: _
Complaint Number: 2170
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: