73 CONGRESS STREET - TRASH COMPLAINT onmr��
s CITY OF SALEM,MASSACHUSETTS
\�`� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR A (978)741-1800 FAx
A (978)745-Q34343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINL!SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2036
Complainant -
Address: Phone:
i
Investigated By: Date:
Property Owner/Occupant Name -_ - _ Telephone #: