WALTER STREET - TRASH COMPLAINTS Y. ��A
"n�„� ! CITY OF SALEM, MASSACHUSETTS
-' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tx FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2081 _
Complainant ----
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #-