88 CONGRESS STREET - TRASH COMPLAINT 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 LRAMQrN'P SALEM.CO.M
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: /� /�% Time: t , `s- n Received By:
Complaint Number: 1790
Complainant
Address: 17 s '` f - ; ,4 Phone:
Investigated By: Date: _�1 j
Property Owner/Occupant Name Telephone #:
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