WAITE STREET - TRASH COMPLAINT a
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 LRAMDIN(a-'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2034
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone #: