28 Summit Ave #2 Complaint 2-14-2019 115PM CITY OF SALEM, MASSACHUSETTS
_ 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 LRAMDINr.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: Received By: !� l
Complaint L' ber: .2357
Complainant
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Investigated By: _ Date: _
Property Owner/Occupant Name
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