7 FOSTER STREET - RODENT COMPLAINT j�,; r=! CITY OF SALEM, MASSACHUSETTS
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�� '�fi' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
MAYOR TEL.(978)741-1800 FAX(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMI)VOCSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: %1;-z `16 Time: k � Received By: G R(4 r. - C►to-4o1V
Complaint Number: 1883
Complainant T)i A,.> aJ E -
Address: -1 (�"OSTE( S-r a-cc-r Phone: 9 7 7 4i'5 7,o 6 -Z
Investigated By: //'( %i i.v . r Date: l�
Property Owner/Occupant Name Telephone #: >in -
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