321 LAFAYETTE STREET - TRASH COMPLAINT ( r CITY OF SALEM, MASSACHUSETTS
��aV'""'� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN a SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-.
Complaint Number: 2031
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone#: