HILLSIDE AVENUE - RODENT COMPLAINT n. CITY OF SALEM, MASSACHUSETTS
rt' Y ,• 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 SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ; Time: Received By:
Complaint Number: 2196
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Complainant
Address: ` Phone:
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Investigated By: 1' 1 Date:
Property Owner/Occupant Name Telephone #:
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