42 BUFFUM STREET - TRASH COMPLAINT M m) CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
M1 FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Da Time: - Received By:
Complaint Number: 2207
Complainant
Address: Phone:
I
Investigated By: Date: -
Property Owner/Occupant Name Telephone#: