29 HANSON STREET - TRASH COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
f LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN0aSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ._- " _ - u" ? Time: Received By:
Complaint Number: 1778
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Investigated By: !�, . Date:
Property Owner/Occupant Name Telephone #:
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