63 BEAVER STREET - TRASH COMPLAINT Gn Wt
CITY OF SALEM, MASSACHUSETTS
`'• BOARD OF HEALTH
KIMBERLEY~DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIIQOSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2326
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: _"