112 BOSTON STREET - TRASH COMPLAINT �iaxrq.,
CITY OF SALEM, MASSACHUSETTS
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 LRAMDINaSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2377
Complainant - - -
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: n
nwyur ei g2e41-'r f'�J.