159 FEDERAL STREET - TRASH COMPLAINT oavrrq�
,a_ CITY OF SALEM, MASSACHUSETTS
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__� BOARD OF HEALTH
MBERLEY DRISCOLL 120 WASHINGTON STREET,47H
KI FLOOR
MAYOR (978)741-1800
FAX
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CY-FS LRAMDINL¢SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2104
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone #: