36 WEST AVENUE - TRASH COMPLAINT CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
l MAYOR TEL.(978)741-1800
J FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN'a-SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: �� Received By:
Complaint Number: 2142
Complainant
Address: Phone:
Investigated By: (A A Date:
11-1 .
Property Owner/Occup t Name Telephone #:
i
i `