134 BRIDGE STREET - TRASH COMPLAINT (2) � n CITY OF SALEM, MASSACHUSETTS
_ BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDI!N(t'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-
Complaint Number: 2190
Complainant ' y '
Address: 7 Phone:
Investigated By: Date: y i _
Property Owner/Occupant Name - _ Telephone#: _ _