41 Endicott Street Complaint 5-16-2019 CITY OF SALEM,MASSACHUSLTTS
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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 LRAMDINrySALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: _ i2- Received By: V
Complaint Number: 2443
Complainant
Address: �' "� ' Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: