18 PIEDMONT STREET - STREET FILE nNU
CITY OF SALEM, MASSACHUSETTS
a 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 u SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2395
Complainant
Address: / Phone: —
Investigated By: Date:
Property Owner/Occupant Name Telephone#:
HOT