27 FAIRMOUNT STREET - TRASH COMPLAINT OF SALEM, MASSACHUSETTS
aCITY
BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
CNI FAx(978)745-0343
LARRY RAMDEN,RS/REHS,CHO,CP-FS LRA.MDIN(&SALEM.00M
HEALTH AGENT
COMPLAINT INTAKE FORM
r7
Date: Time: r Received By: C
Complaint Number: 1748
Complainant
Address: Phone:
Ar p 14 C-
nor we-C.L.
Investigated By: Date:
Property Owner/Occupant Name Telephone