POND STREET - RODENT COMPLAINT ,: CITY OF SALEM, MASSACHUSETTS
�y�,;;;;���l BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDD;,RS/REHS,CHO,CP-FS LRAMDIN(W-SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
—djDate: ! Time- Received By:
Complaint Number: 1806
Complainant PIC,
s _
Address: �n( >>.t =re _Phone:
or
/ f j` i n �• :/ ' I (PC ✓lam -4�� T /SIAI I/,
I
Investigated By: Date:
r.
Property Owner/Occupant Name Telephone#: -
Aj6 YoCr?f-;� V, ! SS of s ���SPKfP C`� �( `f7/7cA 6.1,
•JI f '� !X✓/Cil/t' �•,( U I` ; !•(, t'(l,1 air) L4 JL N`CI �) yj) fti e UoVeG!
lie( dIl Lc' J `j 00