CENTRAL STREET CENTURY BANK COMPLAINT 4-5-19 cFl—r .
x 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 LRAMDIN:j'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: _ Time: Received By:
Complaint Number: 2398
Complainant
Address: Phone: 1
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Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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