84 HIGHLAND AVENUE - TRASH COMPLAINT 4-�
a, ti CITY OF SALEM, MASSACHUSETTS
"-_.9 BOARD OF HEALTH
KIMBERLEY-DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
I \ MAYOR TEL.(978)741-1800
1 l FAX(978)745-0343
L ARRY RA1iDIN,RS/RF"HS,CHO,CP-FS LRAMDIN(R)SALFM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: �7 Time: �. _> ' Received By:
Complaint Number: 1789
Complainant / It'lAlce
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1.ddress: 1 I'?��'"l j J t Phone:
Investigated By: J�ff—re'vEeiir)"V Date:
Property Owner/Occupant Name Telephone #:
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