159 FEDERAL STREET - TRASH COMPLAINT (2) CITY OF SALEM,MASSACHUSETTS
A' ' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,e'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN!¢'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-
Complaint Number: 2080
Complainant _
Address: - Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: