11 CIRCLE HILL ROAD - TRASH COMPLAINT :=+
RRW
CITY OF SALEM, MASSACHUSETTS
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 LRAMDIN(4SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2071
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: _