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POSi4'V �aX Note i 7671; <br />To'.N��^. 1 iWOO" <br />C61Dr�7L /' <br />Phone # <br />1 !. :e <br />Fax �*5 <br />'Facility Name: �11 <br />�uST�n <br />Facililty Location: <br />zr_spec for : <br />an tluaquin County <br />Envi!�onmental Health Division <br />445 S. San Joarmi n Street <br />SCoc4ct=on a 95201 <br />(209 } 4n46 3420 <br />K,0_ rAU <br />Lacta .vond Ey, <br />ratune: ; wind Conditions: <br />" i { — <br />,`r <br />Facility File <br />Ntsmbar :. <br />i.Atars Conditionb: <br />Gro".j &, e +- <br />tractants: <br />l:'xspec i o Date! <br />�l1ay? <br />T" me Xms <br />ime out: <br />Icy conditions <br />ClauJ{c", <br />Scuddfmr. ;grill. Count / S�eci.es <br />x 6 �. <br />2 7 <br />3 + 8 <br />4 9 _— <br />Check (f} Presence of MosqulLues, Wasps, Cockroaches and other Vectors! <br />Box <br />t-s�nthlyj n <br />Number, of Domestic Rate Trapped (Since previous Inspection): <br />(Morlthly� (I On <br />gumber ot. Field Rodents 4bserred (Signs of Presence ;. <br />(Motat:hlyYj <br />Uaor: <br />etre xazara: i <br />rall <br />Eli ttvr: <br />Comments <br />EFl 09 04 <br />TOTAL P.01 <br />