26 PLEASANT STREET - RODENT COMPLAINT Nmr�
CITY OF SALEM, MASSACHUSETTS
.�`♦`nf��� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,47 FLOOR
MAYOR TEL.(978)741-1800
1 FAX(978)745-0343
( LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMD1Nra)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: z. ATime: Received By:
Complaint Number: 2099
Complainant
Address: . Phone:
Investigated By: I' r� `` `� Date:
Property Owner/Occupant Name Telephone#:
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