183 FEDERAL STREET - RODENT COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR A (978)741-1800 FAx
A (978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(aiSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: r Time: _ Received By:
Complaint Number: 2256
Complainant
Address: ` f — - - Phone:
Investigated By: � �' ' n� •�-• �t �� Date:
Property Owner/Occupant Name - Telephone #: