VILAS COUNTY PUBLIC HEALTH
DEPARTMENT
Environmental Health
330 Court Street
Eagle River, WI 54521
F-45002A (Rev. 09/08)
Retail Food Establishment Inspection Report
Establishment Information
Facility Name
Facility Type
Facility ID #
Facility Telephone #
FOREST LAKE COUNTRY STORE
ASPR-8ETLBL
Small Potentially Hazardous
715 547-8222
Facility Address
6256 B HWY
LAND O LAKES , WI 54540
Licensee Name
FOREST LAKE COUNRTY STORE,
LLC
Inspection Information
Inspection Type
STATE OF WISCONSIN
s. 97.30, s. 254.61, Subchapter VII,
Wis. Stats.
Licensee Address
PO BOX 537
LAND O' LAKES , WI
54540
Inspection Date
Routine
Total Time Spent
07/22/2016
Equipment Temperatures
Reach-in display
True refrigerator
Victory reachin cooler
Crosley
Victory front cooler
41
35
33
34
25
Description
Temperature (Fahrenheit)
Food Temperatures
Tomatoes CH
Onions CH
Ice cream scoop dip water
41
38
37
Description
Warewashing Info
Three
manual
compartment
sink
Machine Name
Sanitization
Method
Thermo Label
PPM
200
Sanitizer Name
Quat tabs
Sanitizer Type
Quat
Certified Manager
MARK J GOSTISHA
KBRN-9BWQBL
05/10/2017
Name
Temperature (Fahrenheit)
Certificate #
Temperature
Certificate Expiration
OPERATOR - The violations in operating procedure or physical arrangement indicated below must be
corrected by the next routine inspection or by a date specified in this report.
Observed Violations
Total # 0
Comments
FOREST LAKE COUNTRY STORE (Inspection Date: 07/22/2016)
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Any operator aggrieved by an order of this department under this chapter may request a hearing as
provided in ch.227 statute, if state licensed, or a local ordinance if licensed by an agent health
department.
Person in Charge
FOREST LAKE COUNTRY STORE (Inspection Date: 07/22/2016)
Sanitarian
TAYLOR HAYNES
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