54 MASON STREET - TRASH COMPLAINT �. CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
1 FAX(978)745-0343
I LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCaSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2161
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#: