19 West Ave #1 Complaint 3-9-2018 V
CITY OF SALEM, MASSACHUSETTS
C��Tq
11 -
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa-SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: ,F �l.La�! Received By:, re
. y
Complaint Number: 2070 _
Complainant pl S , _,�
Address: J— l AVLiLle-- .Z Phone: �;�4 3 lf-30 S
r p
� r �
t/ S 1 V4 N -i Qas' � _
Investigated By: Date:
Property Owner/Occupant Name Telephone#: _