Kernwood Country Club Complaint 6-11-2019 A T
CITY OF SALEM, MASSACHUSETTS
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 LRAMDIN(a?SALEM.CQM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: q, Received By: a
Complaint Number: 2458
Complainant _
Address: Phone:
1- 4
Investigated By: _ _ Date:
Property Owner/Occupant Name -- _Telephone #: