26 CROSS STREET - TRASH COMPLAINT ( CITY OF SALEM, MASSACHUSETTS
- BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
�1 MAYOR TEL.(978)741-1800
FAx(978)745-0343
~' LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINOISALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2011
Complainant
Address: Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: