HANSON STREET - TRASH COMPLAINT erg .
'n ,r CITY OF SALEM,MASSACHUSETTS
n� 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(R�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 'j Time: Received By:
Complaint Number: 2178
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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