20 ORNE STREET - RODENT COMPLAINT CITY OF SALEM, MASSACHUSETTS
�
z f
W. 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 LRAMDINnSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2229
Complainant
Address: Phone:
.e4
t
Investigated By: Date:
Property Owner/Occupant Name__ Telephone#: