5 LEMON STREET - RODENT COMPLAINT nNWZ`,q'
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Ta FLOOR
�} MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCn'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: f ' Time: T _ Received By:
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Complaint Number: 2248
Complainant oc C-
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Address: Phone:
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Investigated By: �,�,�(,� t Date:
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