5 LEACH STREET - HOUSING COMPLAINT - MICE �LI-I
CITY OF SALEM MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
-, LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINA-SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2140
Complainant _ _
Address: Phone:
Investigated By: - Date: -
Property Owner/Occupant Name_ - Telephone #:
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