9 Piedmont Street Complaint 4-23-2019 `nNUiT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR FAX(978)745-03433
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINfp?SALEM.COM
HEALTH AGENT
4S COMPLAINT INTAKE FORM
Date: Time: ' Received By:
Complaint Number: 2417
Complainant—4-V1ffyh#Whu
Address: ` �r �� Phope:
1
Investigated By: _ Date:
Property Owner/Occupant Name Telephone#: