134 BRIDGE STREET - TRASH COMPLAINT yn 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 LRAMDIN[a)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received
Complaint Number: 2151
Complainant
Address: Phone:
Investigated By: - Date:
Property Owner/Occupant Name Telephone #- _ -