14 NICHOLS STREET - HEAT COMPLAINT `n-
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CITY OF SALEM, MASSACHUSETTS
\y• ;� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a S.ALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Ti �/ �,., Received By:
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Complaint Number: 1750
Complainant G� I
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