25 BOARDMAN STREET - TRASH COMPLAINT %j��',oNUIGI
=y CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: ,
Complaint Number: 2351
Complainant
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: