134 BRIDGE STREET - TRASH COMPLAINT (3) rr '�F� CITY OF SALEM, MASSACHUSETTS.
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\y� � 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 LRAMDINL'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: S
Complaint Number: 2139 _
Complainant
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Address: 11/ Phone: �r�
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Investigated By: _ Date:
Property Owner/Occupant Name - Telephone #: