254 ESSEX STREET - RODENT COMPLAINT CITY OF SALEM, MASSACHUSETTS
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',,u,,t BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-0343343
LARRY RAMDEQ,RS`REHS,CHO,CP-FS LRAMDIN(2.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 9 1 1 Time: �, 3�';,;:, Received By: r v ;
Complaint Number: 1770
Complainant :; ( l _J V
Address: ��x ce. Phone: 7g 1f S C9
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Investigated By ' : {�" Date:
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