5 LANGDON STREET - RODENT COMPLAINT ''n.'� CITY OF SALEM, MASSACHUSETTS
4z±x�._ BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,e FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN6a6ALEM.00M
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-
Complaint Number: 2201
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#:
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