321 JEFFERSON AVENUE - TRASH COMPLAINT i�VU��
1
;ar, CITY OF SALEM, MASSACHUSETTS
�\.` �; BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.FAx(978)741-
1800
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(n.'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2018
Complainant
Address: '�'� - - :�' Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#: