NORTH PINE STREET - RODENT COMPLAINT I-r, G CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN,u SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: ;_,'/11 Received By:
Complaint Number: 2109
Complainant
Address: phone:
Investigated By: Date:
Property Owner/Occupant Name_ Telephone#:
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