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Department of Alcoholic Beverage Control <br />State of California <br />APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE <br />ABC 211(6/99) <br />TO:Department of Alcoholic Beverage Control File Number: 660995 <br />3021 REYNOLDS RANCH PKWY Receipt Number: 2919478 <br />STE 150 Geographical Code: 3907 <br />LODI, CA 95240 Copies Mailed Date: August 1, 2024 <br />(209) 371-6761 Issued Date: <br />DISTRICT SERVING LOCATION. LODI <br />First Owner: MIKASA BISTRO INC <br />Name of Business: MIKASA JAPANESE BISTRO <br />Location of Business: 15138 HARLAN RD <br />LATHROP, CA 95330-9754 <br />County SAN JOAQUIN <br />Is Premises inside city limits Yes Census Tract: 0051.19 <br />Mailing Address:(If different <br />from <br />premises address) <br />Type of license(s): 47 <br /> Dropping Partner: Yes No <br />Transferor's license/name: 509713 / MIKASA JAPANESE BISTRO INC <br />License Type Transaction Type Master Secondary LT And Count <br />47 - On-Sale General Eating Place PER <br />License Type Transaction Description Fee Code D LI p Date Fee <br />Application Fee PERSON TO PERSON TRF NA o 08/01/24 $1,470.00 <br />Application Fee ISSUE TEMPORARY PERMIT NA 1 08/01/24 $100.00 <br />Application Fee FEDERAL FINGERPRINTS NA 2 08/01/24 $48.00 <br />Application Fee STATE FINGERPRINTS NA 2 08/01/24 $78.00 <br />47- On-Sale General Eating Plac ANNUAL FEE P20 0 08/01/24 $1,185.00 <br />Total $2,881.00 <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: August 1, 2024 <br />Applicant Name(s) <br />MIKASA BISTRO INC <br />era 0 -S2A09 80 <br />5