24 GROVE STREET - TRASH COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-]800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN6ZSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: f Time: Received By:
Complaint Number: 2268
Complainant _
Address: ; Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: