24 DEARBORN STREET - TRASH COMPLAINT =` CITY OF SALEM MASSACHUSETTS
ram.; BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASI41NGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMD1N6 SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2418
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Address: �T -. ` Phone: T_
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Investigated By: Date:
Property Owner/Occupant Name _Telephone#:
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