56 WARD STREET - STREET FILE 6 Fxgl''
s, g 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 LRAMQUM[i SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: X% �610vti Time: ` 0 :ao-! Received By:
Complaint Number: 1350
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Investigated By: Date:
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