138 BRIDGE STREET - TRASH COMPLAINT ' } CITY OF SALEM MASSACHUSETTS
4
'2 ` BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTOM STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(WSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2263
Complainant 1
Address: / / r�- Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone #:
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