26 PLEASANT STREET - TRASH COMPLAINT n. ,\� CITY OF SALEM, MASSACHUSETTS
��� ' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
( MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2424
Complainant
Address: Phone:
Investigated By: + _ Date:
Property Owner/Occupant Name Telephone #: