391 Essex Street Complaint 4-23-2019 ci,
a. CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,47H FLOOR
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MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDENriVSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: � � Time: � 13 Received By:
Complaint Nuinher: 2412
Complainant � j I A!5 y _
Address: _Phone: 6— j
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Investigated.By: _ _Date:
Property Owner/Occupant Name- ___ Telephone