292 Essex Street Complaint 2-19-2019 CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,eH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN,Q'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: 1& 41Q Received By: /7
Complaint Number: 2359
Complainant 2 V
Ad�rress: r' Phone: /
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Investigated By: Date: _
Property Owner/Occupant Name Telephone #: