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63 PALMER STREET - TRASH COMPLAINT \ . r m CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T13 FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINC¢SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2285 Complainant Address: Phone: - Investigated By: Date: Property Owner/Occupant Name Telephone#: r CITY OF SALEM,MASSACHUSETTS ,G . m BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4r"FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a�SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2295 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone#: CITY OF SALEM,MASSACHUSETTS rM BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR MAYOR A (978)741-1800 FAX A (978)745-0343343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa'SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2440 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone #-. =n. CITY OF SALEM,MASSACHUSETTS e^1SY'% BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4r"FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIIV{a!SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By-. Complaint Number: 2405 Complainant _ Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone #: i�m� f�fL ��AS cP�o-' I -V A flvis�tc> n���� 1>�(; r�t' (3 1L��V ,�u ��n,��; �ctn 1.• 46r ) rkjr ►0 %o . {"n � CITY OF SALEM MASSACHUSETTS n�' BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN`fSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2395 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone #: 1 N'y�-- 5- s-.0-%n t64%,: r-) *4r:) 11.1 r74 < u r'i U) a CITY OF SALEM,MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,41"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 —� LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa'SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2355 Complainant _ Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone#: CITY OF SALEM,MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,473 FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(kSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2337 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone#: nnwr�., CITY OF SALEM,MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR MAYOR TEL.(978)741-1800 \ `t FAX(978)745-0343 -- LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN u SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: r 1 Time: Received By: Complaint Number: 2325 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone #: a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T13 FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(iLSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2309 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone #: a CITY OF SALEM,MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR MAYOR (978)741-1800 FAx FAx(978)745-0343343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN a)SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 2308 Complainant Address: Phone: Investigated By: Date: Property Owner/Occupant Name Telephone #: i n CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(B)SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM ifr Date: '� �L>�% -.L� Time: Received By: 4 ¢ 4 ;L Complaint Number: 2298 Complainant Address: C_i., f t S, - ¢- Phone: r _ .1 �f Investigated By: Date: Property Owner/Occupant Name Telephone #-. Num� CITY OF SALEM, MASSACHUSETTS , BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIti,RS%REHS,CHO,CP-FS LRAMDINCkSALEM.COM 11EALTH AGENT COMPLAINT INTAKE FORM ro Date: �'!r y!, -fTf Time: : J�Jh, Received By: Y� Complaint Number: 1738 Complainant Address: Phone p 1 _, , YcsY! Tj el.j GnrAi lizze-A j a4 J 014 fc. ✓C_.1 ,if )r T Investigated By: 1— C- Date: z/��.-1���. Property Owner/Occupant Name Telephone #: c /6 nwAev' ' A r)ar-J�m e Y-4f,7 1 'P1 0 C-/- d 51,111-1d I S V ! c( CITY OF SALEM,MASSACHUSETTS \g. BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR nMAYOR AX(978)741-1800 F Ax(978)745-0343343 LARRY RAMDIN,RS REHS,CHO,CP-FS LRAMDINr'SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: / }i Received By: _4 Complaint Number://1739 Complainant Address: Y ��e�� 2 i' ,.J1 i L ���i�-� Phone: I L 3 _- Investigated By: f�.� j( Date: Property Owner/Occupant Name Telephone #: AM A/I V tfj -A r ! , �j v =s CITY OF SALEM, MASSACHUSETTS sn;r ns/ BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4rH FLOOR r MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CF-FS LRAMDIN(a),SALEM.COYt HEALTH AGENT COMPLAINT INTAKE FORM Date: F!'t` �� 7 Time: ,r Received By: _ 1� Complaint Number: 1736 Complainant Q n o n V M I , Address:?" S�-ree t Phone: T i f '4 0 u ill n Investigated By: � FS��osv Date: Property Owner/Occupant Name Telephone #: - Ce,,J - J. �" I ® 1 a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR MAYOR FAX (978)741-1800 F Ax(978)745-0343343 LARRY RAMDIN,RS/REHS,CIIO,CY-FS LRAMDIN[[WSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM n,, Date: Time: Received By: Complaint Number: 1737 Complainant 7 Address: %�L Phone: i om -v' 7 Investigated By: �� Date: J- ]LI Property Owner/Occupant Name ' t_ �jj Telephone #: Awl I CA, 4�4 i \Ne(k jd L-1 JCA CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR MAYOR FAX(978)745-03433 HARRY RAMDIN,RSiREHS,CHO,CP-FS LRAMDI a)SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: _� (f ,� Received By: awl-c- Complaint Number: 1734 Complainant (� Address: Phone: 'I )d Sfe -d4fiw L111 -C mA 2�) cat'd 1 v P n( Investigated BY: � Date: Property Owner/ ccupant Name j i�f L Telephone #: PO-) (111M (JAC a ��n\QIfAR r'= � 1� CITY OF SALEM,MASSACHUSETTS � U BOARD OF HEALTH zvn u�^i KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDItiraSALF;M.COM HEALTH AGENT COMPLAINT INTAKE FORM awrc Date: r�cr ' Time: 3 Received By: V96-41 0 Complaint Number: 1735 Complainant , Address: Phone: ,��✓� ��� ��c. S G.r. 4� ,.•. -�� e:,r?n Sc P c L n Investigated By: _l t7 fL FV earnsv Date: Property Owner/Occupant Name Telephone #: a 4 04 a CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY R NIDIN,RS/REHS,CHO,CP-FS LRAMDINr'SALF.NI.COM HEALTH AGENT COMPP}LAINT INTAKE FORM Date: A a Time: vr aM Received By: Complaint Number: 1732 Complainant i Address: J !U 2 J�E Phone: -Anaal Sf r �` :�af Y.Min I j �Lld-' i'mi, unli ANRYAhMt At idtU ILI LLff Investigated By: Date: 11 --o Property Owner/Occupant Name Telephone #-K Aw,l et/-/ Y giCITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH n„ KIMBERLEY DRISCOLL 120 WASHNGTON STREET,4"'FLOOR y } MAYOR TEL.(978)741-1800 J FAx(978)745-0343 LARRY RAM- DIN,RS/REHS,CHO,CP-FS LRAMDIN�a;SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM , 4 <; B % Date: �_ Time: r7 Received y: i Complaint Number: 1727 Complainant ! Address: ,� f _ �. ��. ;Phone: 4X ' l l A4 L Investigated By: Date: Property Owner/Occupant Name Telephone #: 1 �I ► of du 4rn�orraa CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCdSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: ? 17 Time: Received By: Complaint Number: 1731 j Complainant Address: f Phone: / Fin Tf'G��h E�=i /1 Yf S /a I ii rn �,,:'i a r li `f 4er'nY/IPr 1 t rc-f -YPP� /:n �Wr� �,r�Ci 14 ' An 4- , Investigated By: Date: Property Owner/Occupant Name 1 Telephone #: l ;:ycnsmr; r tipuw___ CITY OF SALEM, MASSACHUSETTS \ �j BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR MAYOR A (978)741-1800 FAX \ w (978)745-0343343 LARRY RAMI)IN,RS/REHS,CHO,CP-FS LRAMDIN(a)SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: �;' 10 ,2.Qj, Time: . -,? r,, Received By: J e -f le Complaint Number: 1730 Complainant - 11A 7- L�49(1-))-21'71 Address: S �!; Phone: 0 n�I L ✓261 /o rot /e I i�;f 1 -r�v r�I Op Gt r ©D a Y7 G ".'6 To, . r(vr DI CA a O.n,er.1 I io re Z17,; �y Investigated By: Date: Property Owner/Occupant Name Telephone #: s„ CITY OF SALEM, MASSACHUSETTS ��"\�"m� BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T13 FLOOR MAYOR (978)741-1800 FAx FAx(978)745-0343343 LARRY RAMDIN,RS/REHS,CHO,CY-FS LRAMDIN('&SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: w' Received By: Complaint Number: 1728 Complainant1 J� Address: l l l Phone:T Investigated By: 1 c: Date: Property Owner/Occupant Name Telephone #: iionw � _ CITY OF SALEM, MASSACHUSETTS wmz� BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHLy1GTON STREET,4T'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDI.NnSALEM.COM IIEALTH AGENT ��, COMPLAINT INTAKE FORM Date: 7,- — r Time: Received By: / i �•/ Complaint Number: 1726 / Complainant Address:_-1 . ��—�-!�1 I' ,�( } c '� Phone: Investigated B Date: g Y� �— 1.f1n�2�1'J Property Owner/Occupant Name Telephone #: dwrklf WO's . a-A r r 11 (( I 1L. f T • L'Alrof>M5 - t nA� �zr 4 e r aL +a ke4 r-. 1 �. CITY OF SALEM, MASSACHUSETTS 94)p�p Y;� BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4r"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM f Date: - 11� Time: ) Received By: Complaint Number: 1724 Complainant ti � Address: (.(�( V �f t �(�(� Phone: J� Z�i Investigated By: Date: Property Owner/Occupant Name Telephone# -- 7,, �.� CITY OF SALEM,MASSACHUSETTS 0 BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMI)INASALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 1723 Complainant Address: /Z / :2 Y —Phone: 4j Investigated By: Date: Property Owner/Occupant Name Telephone#: \Ij �1 �= F� CITY OF SALEM, MASSACHUSETTS \LNG xun � BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY KAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a)SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: �� Time: ` ' Received By: �a Complaint Number: 1722 Complainant ZW4 .J Address: Phone: Investigated By: r.i Date: Property Owner/Occupant Name / Telephone#: II� - CITY OF SALEM7 MASSACHUSETTS 15�'- �N E;,a» BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TI'FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr(VSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: '" Time: Received By: Complaint Number: 1721 Complainant Address: :- � �Ti �, Phone: Investigated By: Date: Property Owner/Occupant Name _ Telephone #: ' a CITY OF SALEM, MASSACHUSETTS BOARD OF I1EALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Ta FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDTN,RS/REHS,CHO,CP-FS LRAMDTNrSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: , Complaint Number: 1720 Complainant L Address: < / i Phone: G ~ fr r � �tri 1 � Investigated By: Y�zy,/ -I IL Date: - Property Owner/Occupant Name Telephone#: %? ;i!2 '; yClxq� V n id 35: CITY OF SALEM, MASSACHUSETTS BOA RD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDLN,RS/REHS,CHO,CP-FS LRAMDIN(a1SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM C Date: -41 N 11Time: ( Received By: I 0 Complaint Number: 1718 Complainant Address: ' Phone: ��(J (rely ;��712 ;� Investigated By: ,( n i`..-,c Dater Property Owner/Occupant Name Telephone#: a 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 LRAMD1TirSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: — t , )7 Time: Received By: - - Complaint Number: 1716 Complainant �•7�r,•�i rrJ71�/! tf Address: r ' ( Phone: ► Investigated By: 1 Date: Property Owner/Occupant frame Telephone #: Lk Ill f 1i � � . � ' CITY OF SALEM,MASSACHUSETTS Y BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,47H FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-034343 LARRY RAMDIN,RSIREHS,CHO,CP-FS LRAMDIN @SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM V Date: _ Time: Received By: r Complaint Number: 1717 Complainant PL Address: r Phbie,' / ! l Investigated By:-... Date- Property ��' " , .�r Property Owner/Occupant Name Telephone #: _ , � 7 J) 7, le UO + � CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR MAYOR TEL.(978)741-1800 FAX FAx(978)745-0343343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDEVri�SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 1715 Complainant Address: %% ��� Ir�_- } Phone: l i Investigated By: i c Date: �� / �Z- Property Owner/Occupant?VTame Telephone #: -1 1ra , f / 7ry)y %� �� CITY OF SALEM MASSACHUSETTS \�„nE 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 LRAMDI'.VQSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: _ Time: l� ` ' 3 j _ Received By: l �� ., 1 '; i , r.4•-p-' Complaint Number: 1714 Complainant s Address: ,"�2 1'; �;. �� i J T Phone: Ij td Investigated By: /� c?i/("�/l�_� Date: Property Owner/Occupant Name P/A/ � � r Telephone #: jf(J. � CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T11 FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 01 LARRY RAM- DIN,RS/RE1JS,CHO,CP-FS LRAMDIN._SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: If7 Time: ,' �� J#I Received By Complaint Number: 1710 Complainant Address: 4 Phone: 4 A A 09 i!6 �0 IIJ ") 'g n 1, 1 a/' 4 Investigated By: Date: Property Owner/Occupant Name Telephone fi u 4fed CITY OF SALEM, MASSACHUSETTS a BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR TEL.(978)741-1800 j MAYOR FAX(978)745-0343 LARRY RAMDTN,RS/REHS,CHO,CP-FS LRAMDIN(WSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 1797 Complainant f, I n/ 1z Address: Phone: LIZ Investigated By: Date: Property Owner/Occi4lant Name _ Telephone#: 1-d Oh i eqJf22L1_)- 4zz L L)l 1 ` S CITY OF SALEM, MASSACHUSETTS 0 BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY R-AmDrN,RS/REHS,CHO,CP-FS L RAM. DIN Ca S A LF M.C OM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 1709 Complainant Address: Phone: 21 J2 VaL 4)Za L11-1 2-Z//- Investigated By: 7Date:Property Owner/Occupant Name Telephone #: c4 Al", 4,, Elf '�k r 7 7 ti CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR MAYOR (978)741-1800 FAx FAx(978)745-0343343 LARRY RAMDIN,RS/REHS,CIIG,CP-FS LRAMDIN(d SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Received By: Complaint Number: 1707 Complainant v t , Address: ,,! r Phone: / 1 Investigated By: _I ;1 PCB " Date: Property Owner/Occupant Name F ,, Telephone #: 4' t CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAYIDLVr'SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: �f �� Time: -1 "", ,i1F Received By: .. Complaint Number: 1704 // Complainant 1'' ;all - Address: , ��� Phone: ,/' t_�7- Ij)p .J 1 r Investigated By: Date: /'l4 7 Property Owner/Occupant Name Telephone # r a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T11 FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CF-FS LRAMDINIISALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: ` ' Time: Received By: Complaint Number: 1703 Complainant Address: Phone: ---- 41 Investigated By: Date: Property Owner/Occupant Name Telephone #: