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anau,„ f San Joaquin County <br /> >. p <br /> r 'za Environmental Health Department <br /> " 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www sioov ora/ehd <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: JEFFERSON ESD-JEFFERSON SCHOOL, 7500 LINNE RD , TRACY 95376 <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp 120-F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp 100°F <br /> FOOD ITEM LOCATION --TEMP°F--COMMENTS <br /> Milk cooler--41.00°F <br /> NOTES <br /> Ok to re-open once cleaned. <br /> DM-50ppm chlorine <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 <br /> �isr-equired,fees will be assessed at the current hourly rate. <br /> �io <br /> Received by: V a-mra—ft Name and Title: Ramon Project Engineer <br /> EH Specialist: MELISSA NISSIM Phone: (209)468-3168 <br /> FA0003207 SR0068814 SC623 12/29/2015 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />