15 REAR FRANKLIN STREET - ODOR COMPLAINT (2) "r CITY OF SALEM,MASSACHUSETTS
yn�3 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(,&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2094
Complainant
Address: ` - Phone:
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Investigated By: _Date:
Property Owner/Occupant Name Telephone #: