Broadway Complaint 5-13-2019 CITY OF SALEM, MASSACHUSETTS
Y� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN a.)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: r Received By:
Complaint Number: 2437
Complainant I�-
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Investigated By: Date:
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