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COMPLIANCE INFO_2015-2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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4580
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1600 - Food Program
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PR0160023
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COMPLIANCE INFO_2015-2019
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Last modified
11/19/2024 3:46:01 PM
Creation date
6/18/2019 8:45:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2015-2019
RECORD_ID
PR0160023
PE
1625
FACILITY_ID
FA0001099
FACILITY_NAME
PHILLIPS FARMS
STREET_NUMBER
4580
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
APN
05516050
CURRENT_STATUS
01
SITE_LOCATION
4580 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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I <br /> Department of Alcoholic Beverage Control State of California <br /> • ' APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) <br /> ABC 211(6/99) <br /> TO:Department of Alcoholic Beverage Control File Number: 374544 <br /> 31 E CHANNEL ST Receipt Number: 2286785 <br /> ROOM 168 Geographical Code: 3902 <br /> STOCKTON,CA 95202 Copies Mailed Date: April 2,2015 <br /> (209)948-7739 Issued Date: <br /> DISTRICT SERVING LOCATION: STOCKTON <br /> First Owner: PHILLIPS FARMS LLC <br /> Name of Business: MICHAEL DAVID WINERY <br /> Location of Business: 4580 W HIGHWAY 12 <br /> LODI,CA 95242 <br /> County: SAN JOAQUIN <br /> Is Premise inside city limits? Yes Census Tract 0041.06 <br /> Mailing Address: <br /> (If different from <br /> premises address) <br /> Type of license(s): 02,20,81 <br /> Transferor's license/name: Dropping Partner: Yes No <br /> License Type Transaction h12e Fee Type Master Dup Date Fee <br /> 02-Winegrower STOCK TRANSFER GLIM Y 0 04/02/15 $100.00 <br /> 20-Off-Sale Beer And Win STOCK TRANSFER NA Y 0 04/02/15 $100.00 <br /> 81-Wine Sales Event Perm STOCK TRANSFER NA N l 04/02/15 $100.00 <br /> Total $300.00 <br /> Have you ever been convicted of a felony? No <br /> Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the <br /> Department pertaining to the Act? No <br /> Explain any"Yes"answer to the above questions on an attachment which shall be deemed part of this application. <br /> Applicant agrees(a)that any manager employed in an on-sale licensed premises will have all the qualifications <br /> of a licensee,and(b)that he will not violate or cause or permit to be violated any of the provisions of the <br /> Alcoholic Beverage Control Act. <br /> STATE OF CALIFORNIA County of SAN JOAQUIN Date: April 2,2015 <br /> Under penalty of perjury,each person whose signature appears below,certifies and says:(1) He is an applicant,or one of the applicants,or an executive <br /> officer of the applicant corporation,named in the foregoing application,duly authorized to make this application on its behalf;(2) that he has read the <br /> foregoing and knows the contents thereof and that each of the above statements therein made are true;(3) that no person other than the applicant or <br /> applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the license(s)for which this application is made; <br /> (4) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an agreement entered into more than ninety <br /> (90)days preceding the day on which the transfer application is filed with the Department or to gain or establish a preference to or for any creditor or <br /> transferor or to defraud or injure any creditor of transferor;(5) that the transfer application may be withdrawn by either the applicant or the licensee with <br /> no resulting liability to the Department. <br /> Effective July 1,2012,Revenue and Taxation Code Section 7057,authorizes the State Board of Equalization and the Franchise Tax Board to <br /> share taxpayer information with Department of Alcoholic Beverage Control.The Department may suspend,revoke,and refuse to issue a license <br /> if the licensee's name appears in the 500 largest tax delinquencies list.(Business and Professions Code Section 494.5.) <br /> Applicant Name(s) Applicant Signature(s) <br /> See 211 Signature Page <br /> PHILLIPS FARMS LLC <br />
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