PRINCE STREET COURT - TRASH COMPLAINT ot*�UItRd..
n „ CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tf'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(n SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-
Complaint Number: 2119
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: