414 ESSEX STREET - TRASH COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OFHEALTII
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4...FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMD1N,RS/REIIS,CHO,CP-FS LRAMDINCSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: f Received By:
Complaint Number: 1760
Complainant I e-1QA0r^
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Address- Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: