11 ENGLISH STREET - TRASH COMPLAINT WI CITY OF SALEM,MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMI)IN,RS/REHS,CHO,CP-FS LRAMDIN,iVSALEM.00M
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: f7zz "�f ��l, - /. Time: Received By:
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Complaint Number: 1689
Complainant
Address: Phone: a
42 VIA, f)
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Investigated By: Date:
Property Owner/Occupant Name Telephone #:
-Vy 4�71
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