40 BOARDMAN STREET, #1 COMPLAINT 6-12-2019 a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KINIBF,RLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
+ MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDLN@SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: A Received By:�3
Complaint Number: 2462
Complainant
Address: 40 Boa.✓' m.,sib`{" Phone: --3' — 5 O
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Investigated By: Date: _
Property Owner/Occupant Name—Ge,E r Telephone
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