392 ESSEX STREET - TRASH COMPLAINT 01i"R'Dal
CITY OF SALEM, MASSACHUSETTS
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(2)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ` (� Timer Received By:
Complaint Number: 2035
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