5-7 Ocean Terrace Complaint 2-28-2019 ONIIfTA V • 1 L'-
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CITY F SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Te FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMD1N6V SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: j ��rrt� Received By: :
Complaint Number: 2371
Complainant.G - V
Address: 10 cam, Te r� azp� Phone:
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone#: