20 Pingree Street #2 Complaint 11-30-2017 S nNwrgq
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
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KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINna SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: /��'o Time: `i Received By: 4Ar
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Complaint Number: 2014
Complainant 0
Address: Phone: q�, /l�
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Investigated By: _ Date:
Property Owner/Occupant Name _ Telephone #:
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