9 SPRING STREET - TRASH COMPLAINT i
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=n ml CITY OF SALEM, MASSACHUSETTS
�`, BOARD OF HEALTH
KIMBERLERISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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'Date: Time: Received By:
Complaint Number: 2394
Complainant -
Address: f Phone:
Investigated By: �I 1 f Date:
Property Owner/Occupant Name Telephone#:
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961A W- j
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