FLINT STREET - TRASH COMPLAINT CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4'H FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN[2SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2105
Complainant
Address: , Phone: ._j`�f�
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Investigated By: _ _ Date:
Property Owner/Occupant Name Telephone#: