22 Charles Street Complaint 5-1-2019 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 LRAMDIN('SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: ! +- Time: j �� _ Received By: . - S
Complaint Number: 2427
Complainant
Address: 23_C ej +rem+ Phone:
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Investigated By: _ Date:
Property Owner/Occupant Name Telephone#: