256 JEFFERSON AVENUE - COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
�5 KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN,` SALEN1.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: =E Received By:
Complaint Number: 1780
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