34 HATHORNE STREET - TRASH COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,,f"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDI\,RS/REHS,CHO,CP-FS LRAMDIN u SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: I`Z r7 Time: Received By-.
Complaint Number: 1785
Complainant
Address: Phone
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: