24 Lemon Street #2 Complaint 6-10-2019 = CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Ti3 FLOOR
( MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(q)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2454
Complainant +
Address: ---Phone:
'T, L2.
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Investigated By: Date:
Property Owner/Occupant Name______ ___ _ Telephone #: _ _