LAFAYETTE PLACE - TRASH COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4r'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDI N,R.S/REHS,CHO,CP-FS I.RAMDI:V(q-'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: I r; Time: Received By:
Complaint Number: 1781
Complainant ,u 12
Address: Phone:
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Investigated Byr-) ;i)f ( ' r ` Date: It! -i 3
Property Owner/Occupant Name Telephone #:
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