11.5 MASON STREET - TRASH COMPLAINT j�nNI1\
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(yn CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,41H FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2044
Complainant ,
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone#: