8 MEMORIAL DRIVE - TRASH COMPLAINT (2) ON
CITY OF SALEM, MASSACHUSETTS
.'_ BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.FAx(978)741-
1800
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINIa'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2368
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #-