57 BUFFUM STREET - OVERGROWTH, RODENT COMPLAINT 11i I-.-_ I CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
�I MAYOR TEL.(978)741-1800
FAx(978)745-0343
J LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ` Time: �_ , � � Received By: �,
Complaint Number: 1742
Complainant
Address: -'� Phone:
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Investigated By: .!; ��,: . Date: '71
Property Owner/Occupant Name Telephone #:
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