14 SYMONDS STREET - TRASH COMPLAINT s �
3tx CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
' MAYOR TEL.(978)741-1800
FAX(978)745-0343
\� LARRY RAMO N,RS/REHS,CHO,CP-FS LRAMDIN[RTSALEM.COM
HEALTH AGENT
/ COMPLAINT INTAKE FORM
Date: ',) / — Time: ,` Received By:
Complaint Number: 1756
Complainant
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