126-128 NORTH STREET - TRASH COMPLAINT i4al- ' 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 LRAMDINra SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2091 -
Complainant
Address: Phone:
Investigated By: - Date:
Property Owner/Occupant Name Telephone#: