80-82 HATHORNE STREET - TRASH COMPLAINT m CITY OF SALEM, MASSACHUSETTS
Ali_-`�'� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR A (978)741-1800 FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN()SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2153
Complainant
i
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: