ORLEANS AVENUE - RODENT COMPLAINT ,.'uNU1fA
s„ CITY OF SALEM,MASSACHUSETTS
"�.�s,_uj BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP—FS LRAMDINr'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2166
Complainant
Address: Phone:
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Investigated By: Date:
Property Owner/Occupant Name_ Telephone#: