9 BEACON STREET - TRASH COMPLAINT wv)v
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN[a1SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2416
Complainant
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Address: --- .'' - Phone: r7— J
Investigated By: Date: {. ZZ-414.4;-i-;: -i
Property Owner/Occupant Name_ - Telephone #:
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