MARGIN STREET - TRASH COMPLAINT f r �
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINa•:SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2210
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Address: 17 �11 a �_1 -,Z Phone: A
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone #
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