9 Oliver Street #2 Complaint 12-3-2018 a
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 LRAMDINOSALEM.COM.
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Q 26 Time: 7 r , Received By:
Complaint Number: 2317
Complainant Rf5)C"jje--, ,rI'6O
Address: Phone:
i c a in a iPl S G,lLij �1 1 �� C'i
J J -
Investigated By: Date:
Property Owner/Occupant Name Telephone#: __