5 SABLE ROAD WEST - TRASH COMPLAINT ``lf
(? ,, CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR (978)741-1800 FAX
FAX(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(FASALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2353 _
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: