80 Summer Street #3 Complaint 6-19-2019 02-01-
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY RISCOLL 120 WASHINGTON STREET,4"H FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMMN(a_.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: �'�r.� Received By: r V
Complaint Number: 2466
Complainant _ )UC_ _
Address:_ a• U-M+`t - Phone: T nVY7
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Investigated By: _ _ Date:
Property Owner/Occupant Name _ Telepbone