Congress Street Complaint 9-30-2019 a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,eH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINQSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Ll Time: Received By: %;�nkl�z
Complaint Number: 2595
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Address: 1 _ Phone:_(4A 2110 "
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Investigated By: _ _Date:
Property Owner�/Occupant Name_ _ _ __ Telephone #: _