51 PRINCE STREET - TRASH COMPLAINT '
�; k CITY OF SALEM, MASSACHUSETTS
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�' � BOARD OF HEALTH
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KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINnsALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2408
Complainant r7 , ,
Address: i ,,: lP� Phone:
Investigated By: ".y. >> `. ► .a Date:
Property Owner/Occupant Name Telephone #:
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