4 FLORENCE STREET - TRASH COMPLAINT (2) CITY OF SALEM MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(ii'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: i
Complaint Number: 2145 _
Complainant r 1
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Address: :Phone:
Investigated By: Date: _
Property Owner/Occupant Name Telephone #: