5 LAURENT ROAD - TRASH COMPLAINT (2) Ire. CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4 FLOOR
r� MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN�&.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: _ _
Complaint Number: 2017
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone#: _