24 MASON STREET - TRASH COMPLAINT �r }1 CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a!SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: Received By:
Complaint Number: 2120 /
Complainant
Address: �' 1��, „�1 ��S Phone:
Investigated By: ` ' .,� Date:
Property Owner/Occupa�Name Telephone#:
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