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r: � I I I Environmental Health Department <br /> N <br /> Y U <br /> f�■■z�ti� COUNTY <br /> Greorness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: TAMALES&BAKERY DON CARLOS, 313 W ELEVENTH ST,TRACY <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: needed Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: °F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> No Temperature Data Collected <br /> NOTES <br /> OK to permit as a 1617 once annual permit fee is paid ($301). <br /> Pay annual permit fee prior to opening. <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> Received by: Name and Title: Discussed w/Carlos Lara, owner <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> SR0081123 SC523 10/28/2020 <br /> EHD 16-23 Rev.09/16/2020 Page 2 of 2 Food Program Service Request Inspection Report <br />