8 LYNN STREET - NUISANCE RODENT COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
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 LRAMDIN6 SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: `� Time: Y Received By:
Complaint Number: 2103
Complainant
Address: Phone: <r ' '1 ,,t
Investigated By: Date:
Property Owner/Occupant Name Telephone #: