28 Summit Ave #2 Complaint 2-14-2019 CITY OF SALEMI MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,e'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN+a SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: .L Time:
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Complaint Number: 2356
Complainant
Address: 2 ' Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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