FOREST RIVER PARK - TRASH COMPLAINT CITY OF SALEM, MASSACHUSETTS•
1
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR A (978)741-1800 FAX
A (978)745-0343343
LARRY RANIDLN,RS/REHS,CHO,CP-FS LRAMDINPdSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Time: ,' �::�j 12�� Received By: h
Complaint Number: 1795
Complainant "
Address: Phone:
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Investigated By:1� ~r?� Date: //' /3
Property Owner/Occupant Name Telephone #:
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