IRVING STREET - TRASH & RODENT COMPLAINT CITY OF SALEM, MASSACHUSETTS t'
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tx FLOOR �V l
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN,u SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By
Complaint Number: 2189
Complainant
Address: S' ♦ Phone:
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Investigated By: Date: _
Property Owner/Occupant Name _ _ Telephone #:
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