10 HOWARD STREET - TRASH COMPLAINT (2) z� CITY OF SALEM,MASSACHUSETTS
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' � BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Ta FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(WSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: A Time: Received By:
Complaint Number: 2400
Complainant I f 1�.,
Address: _ 1�C t f 1 1 �t i f Phone: (i; 1
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Investigated By: - Date:
Property Owner/Occupant Name Telephone #:
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