SOUTH PINE STREET - TRASH COMPLAINT I �m CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,e'FLOOR
MAYOR (978)741-1800 FAx
FAx(978)745-034343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2077
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone#: