19 HAZEL STREET - TRASH COMPLAINT a
CITY OF SALEM, IVIASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINC&SALEM.COM
HEALTH AGENT
I
COMPLAINT INTAKE FORM
Date: Time: �.�n Received By:
Complaint Number: 2213
Complainant I�.�, f'1 M01 )1 ► L I t E A( 1,V
Address: �[ 1-1 ram" T i( AA,I� l . Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: