10 HOWARD STREET - TRASH COMPLAINT 0 T
�lYs ,n, CITY OF SALEM, MASSACHUSETTS
nJum� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
' LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIM&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2421
Complainant
Address: Phone:
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Investigated By: , Date:
Property Owner/Occupant Name Telephone#:
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