1 Langdon Street Complaint 11-13-2018 o uir
4 n. CITY OF SALEM, MASSAC14USETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN[a1SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: c/
Complaint Number: 2302
Complainant 212 41 4%
.Address: L-:2--A &Q Phone: -- �
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Investigated By: _ Date:
Property Owner/Occupant Name_ Telephone#: