LATHROP STREET - TRASH COMPLAINT '•anwi�
�' rt CITY OF SALEM, MASSACHUSETTS
�e�mm j BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRASIDiS(a.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM jow
Date: Time: F a !�• Received By:
4.—
Complaint Number: 1743
Complainant
Address: (Dnu Phone:
1 � 7 �
Investigated By: _ Date:
Property Owner/Occupant Name - Telephone #: