8 ALLEN STREET - TRASH COMPLAINT /i' �A�d Sy,'
(yr.. CITY OF SALEM, MASSACHUSETTS
� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDTN,RS/REHS,CHO,CP-FS LRAMD1NCkSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2320
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: