PARALLEL STREET - STREET FILE 6rc)m UI?A7
;= CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN W_SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 10 Time: Received By: ALP
Complaint Numben 1988 1• ,,
Complainant CLI 'S�►
Address: 4 f' ��(� \�-� r� Phone:
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Investigated By: � (�II l.� AA_ Date:
Property Owner/Occupant Name Telephone #:
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