17 HAZEL STREET - TRASH COMPLAINT �U6 2 uv!
'= CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4r"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RA.MDIN,RS/REHS,CHO,CP-FS LRAMDIN lASALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: — r Time: Received By:
Complaint Number: 1772
Complainant /M
Address: Phone:
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Investigated By: 1 % Date:
Property Owner/Oct t Name Telephone #:
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