PERKINS STREET - TRASH COMPLAINT (2) 0 CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
J FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(hSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ' `� t Time: Received By:
Complaint Number: 2224
Complainant
Address: Phone:—''
Investigated By: Date:
Property Owner/Occupant Name Telephone #: