46 DOW STREET - TRASH COMPLAINT r, r, CITY OF SALEM,MASSACHUSETTS
�: ?.�- � BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
Ems' LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDMO SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2123
Complainant
Address: `/r j/=. Phone:
Investigated By: Date: _ CS
Property Owner/Occupant Name Telephone #: