9 SABLE ROAD WEST - TRASH COMPLAINT CITY& SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
l FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2240
Complainant
Address: � �Eva .- ��`�6� Phone:_
f
l K �� .-1 f r Y r e7
1
Investigated By: Date: _
Property Owner/Occupant Name_ Telephone#- __ _