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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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1600 - Food Program
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PR0505163
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
9/29/2023 2:57:59 PM
Creation date
8/25/2023 4:10:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0505163
PE
1615
FACILITY_ID
FA0003803
FACILITY_NAME
KETTLEMAN CHEVRON
STREET_NUMBER
601
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04728006
CURRENT_STATUS
01
SITE_LOCATION
601 E KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\jcastaneda
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EHD - Public
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Department of Alcoholic Beverage Control State of California <br /> APPLICATION FOR ALCOHOLIC BEVERAGE LICENSES) <br /> ABC 211(6/99) <br /> TO:Department of Alcoholic Beverage Control File Number: 638991 <br /> 31 E CHANNEL ST Receipt Number: 2732087 <br /> ROOM 168 Geographical Code: 3902 <br /> STOCKTON,CA 95202 Copies Mailed Date: June 23,2022 <br /> (209)948-7739 Issued Date: <br /> DISTRICT SERVING LOCATION: STOCKTON <br /> First Owner: GV EXPRESS MART INC <br /> Name of Business: LODI CHEVRON <br /> Location of Business: 601 E KETTLEMAN LN <br /> LODI,CA 95240 <br /> County: SAN JOAQUIN <br /> Is Premises inside city limits? Yes Census Tract: 0041.04 <br /> Mailing Address:(If different 1649 GIORNO WAY <br /> from EL DORADO HILLS,CA 95762 <br /> premises address) <br /> Type of license(s): 20 Dropping Partner: Yes_ No <br /> Transferor's license/name: 407745 / KSM CORP <br /> License Type Transaction Type Master Secondary LT And Count <br /> 20-Off-Sale Beer And Wine PER Y <br /> License Type Transaction Description Fee Code Dup Date Fee <br /> Application Fee PERSON TO PERSON TRF NA 0 06/22/22 $350.00 <br /> Application Fee ISSUE TEMPORARY PERMIT NA 1 06/22/22 $100.00 <br /> 20-Off-Sale Beer And Wine ANNUAL FEE NA 0 06/22/22 $415.00 <br /> Total $865.00 <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 /> STATE OF CALIFORNIA County of SAN JOAQUIN Date: June 22,2022 <br /> Applicant Name(s) <br /> GV EXPRESS MART INC <br /> S <br />
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