37 BELLEVIEW AVENUE - TRASH COMPLAINT fl
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
y FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CF-FS LRAMDIN(tiSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: / Time: Received By:
Complaint Number: 2111
Complainant
Address: Phone:
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Investigated By: Date: -_l
Property Owner/Occupant Name Telephone #