FEDERAL STREET - PAINT REMOVAL COMPLAINT CITY OF SALEM,1--6-"d BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR A (978)741-1800 FAX
f A (978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a-'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: Received By: _
Complaint Number: 2133
Complainant
Address: Phone:
Investigated By: _ ► Date:
Property Owner/Occupant Name Telephone#:
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