392 ESSEX STREET - TRASH COMPLAINT (2) n I CITY OF SALEM,MASSACHUSETTS
" _ �" BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a_>_ALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2413
Complainant
Address: Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone#:
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