8.5 ALLEN STREET - TRASH COMPLAINT Ilr X CITY OF SALEM, MASSACHUSETTS
4� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T}3 FLOOR
MAYOR TEL.FAx(978)741-1
800
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2246
Complainant 1 -
Address: Phone:
i�
Investigated By: - _ Date:
Property Owner/Occupant Name Telephone#:
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