22 LEMON STREET - TRASH COMPLAINT '�
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7. CITY OF SALEM,MASSACHUSETTS
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BOARD OF HEALTH
,ram. KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tx FLOOR
�( MAYOR TEL.(978)741-1800
1� FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINQSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: r Time: Received By:
Complaint Number: 2218
Complainant
Address: i r. y _'_- Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: