11 BRISTOL STREET - RODENT COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR 'rEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINC&SALEM.COM
11F.ALTH AGENT
COMPLAINT INTAKE FORM
Date. :�° ''�';�� Time: .: Received By:
Complaint Number: 1758
Complainant �� •,
Address: , �-;� 11'r c' Phone: ,� 7
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: