15 REAR FRANKLIN STREET - ODOR COMPLAINT CITY OF SALEM,MASSAC14USETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINra'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
bate: Time: Received By:
Complaint Number: 2101
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name _ Telephone#: