53 Ocean Ave #2 Complaint 1-2-2018 �rw-
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDrW&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ` Time: S.' � Received By:
1 _ /
Complaint Number.: 2032
Complainant
Address: 4'�_ tvt Phone: 1 -
Investigated By: Date:
Property Owner/Occupant Name Telephone #: