1 COURAGEOUS COURT - STREET FILE I
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CITY OF SALEM, MASSACHUSETTS aaafff
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()SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 40R
Time: Received By:
Complaint Number: 1718
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Address: VJJ Phone: �--
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Investigated By: �� I �- Date: } C
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