Loading...
PERKINS STREET - TRASH COMPLAINT 3 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR MAYOR (978)741-1800 FAx FAx(978)745-0343343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LPAMDIN(a)SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM '— Date: c n Time: Received By: L! C Complaint Number: 1899 3 r \ Complainant Address: Phone: CUr SSG � -t G� 1 I � ! �� e, (p ie r L/i i���' ii I\ J Investigated By:",-A 1�� � � ae, �" Date: � �Ali// Property Owner/Occupant Name Telephone #: