8 BAYVIEW CIRCLE - RODENT COMPLAINT r, „E CITY OF SALEM, MASSACHUSETTS
'�'"r BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(Q)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: -_
i
Complaint Number: 2042
Complainant _ / }
Address: �' �7 ' Phone:
Investigated By: Date:
Property Owner/Occupant Name - Telephone #: