95 BOSTON STREET - RODENT COMPLAINT :oiuiia-lo-.
`�. ?� CITY OF SALEM,MASSACHUSETTS
y'� ��"• o 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 LRAMDINCa.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: ' Received By:
Complaint Number: 2102
Complainant '
Address: 1�i � �-)i l}c . Phone: { '
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Investigated By: Date:
Property Owner/Occupant Name _ _ Telephone #: