PINGREE STREET - ILLEGAL TRASH DUMPING COMPLAINT ' sf CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDEN,RS/REHS,CHO,CP-FS LRAMDLN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2352
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: