WINTHROP STREET - TRASH COMPLAINT .'�nfiUR�
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,�n CITY OF SALEM, MASSACHUSETTS
\���3- � 1 BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,47H FLOOR
MAYOR (978)741-1800
FAx
FAx(978)745-034343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINO'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2143
Complainant
Address: Phone: J;
Investigated By: Date: t C
Property Owner/Occupant Name Telephone#:
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