270 WASHINGTON STREET - TRASH COMPLAINT y� CITY OF SALEM, MASSACHUSETTS
� 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 LRAMDINa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2159
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: