SPRING STREET - TRASH COMPLAINT y;�9aa
nl} CITY OF SALEM.y MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINeSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ;� Time: Received By:
Complaint Number: 2294
Complainant _
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#:
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