103 LAFAYETTE STREET - TRASH COMPLAINT un� �
Ihr,., 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 LRAMDINr?SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2227
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #-.