9 ORLEANS AVENUE - RODENT COMPLAINT /c ru r
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M a CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: _ Received By:
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Complaint Number: 2249 _
Complainant
Address: Phone:
Investigated By: —Date:
Property Owner/Occupant Name Telephone #: _
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