5 LAURENT ROAD - TRASH COMPLAINT y CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR A (978)741-1800 FAx
A (978)745-0343343
LARRY RAMDIN,RS!REHS,CHO,CP-FS LRAMDIN(I!SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: 1 Received By: /
Complaint Number: 1713
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Investigated By: - Date.
Property OWner,'Occupant Name Telephone #:
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