10 MAY STREET - TRASH COMPLAINT nwiri�.
CITY OF SALEM MASSACHUSETTS
��� � BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,e13 FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN[aISALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2079
Complainant -
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name / Telephone#:
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