65 WILSON STREET - STREET FILE CITY OF SALEM, MASSACHUSETTS
a BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,41H FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINI4�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: , Time: t;2e Received By: IML
Complaint Number: 1693
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Address: 1 Phone: 99- 31�
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