24 ANDREW STREET - TRASH COMPLAINT al CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR A (978)741-1800 FAX
Fax(978)745-0343343
LARRY RAMDRN,RS/REHS,CHO,CP-FS I.RAMDINr[i'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: A - - Time: ; ` 9 Received By:
Complaint Number: 1752 �" '" i1a,
Complainant j'/.7),�%P
Address: Z v I Phone:
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Investigated By: ' /(y Date:
Property Owner/Occupant Name Telephone #:
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