116 Bridge Street Complaint 2-20-2018 a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBER.LEY DRISCOLL 120 WASHINGTON STREET,44"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: `- � Time: ;�b � Received By: tj
Complaint.Number: 2053
Complainant u
Address 12R ✓� Phone:
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Investigated By: _ Date:
Property Owner/Occupant Name_— _ _Telephone #: