MASON STREET - TRASH COMPLAINT ter,. CITY OF SALEM,MASSACHUSETTS
"TW�f'� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
/ LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN/a SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2420
Complainant _
Address: Phone:
Investigated By: + Date:
Property Ow—ng/Occurant Name Telephone #: