9 Skerry Street Complaint 12-20-2017 Ow-l
CITY OF SALEM MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,41H FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr3SALEM.00M
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: 12 m Received By: �1
Complaint Number: 2030
Complainant Ano
Address: Phone:
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Investigated By: _ _ Date:
Property Owner/Occupant Name _Telephone