1000 Loring Ave #B77 Complaint 4-8-2019 `Nub.
l' 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 LRAMDINQSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: — r1L� = — Received By:
Complaint Number: 2399
Complainant , �,� (�,';Z Vag k)t L l .4
Address: ' Phone:
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Investigated By: _ _Date:
Property Owner/Occupant Name Telephone #: