23 MASON STREET - TRASH COMPLAINT //`wxre
fin' CITY OF SALEM, MASSACHUSETTS
" i' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR (978)741-1800 FAx
FAx(978)745-U343343
LARRY RAMDIN,RS/REHS,CHO,CV-FS LRAMDINr&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2219
Complainant _
Address: Phone:
i�
Investigated By: Date:
Property Owner/Occupant Name Telephone#: