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Department of Alcoholic Beverage Control State of California <br /> APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE <br /> ABC 211(6/99) <br /> TO:Department of Alcoholic Beverage Control File Number: 656943 <br /> 3021 REYNOLDS RANCH PKWY Receipt Number: 2877696 <br /> STE 150 Geographical Code: 3906 <br /> LODI, CA 95240 Copies Mailed Date: March 18, 2024 <br /> (209) 371-6761 Issued Date: <br /> DISTRICT SERVING LOCATION: LODI RECEIVED <br /> First Owner: DRIPPIN CHICKEN INC <br /> MAR 2 2 2021 <br /> Name of Business: DRIPPIN CHICKEN <br /> Location of Business: 3099 N.TRACY BLVD E N V I ICON M E N TA L H E A LT H <br /> TRACY,CA 95376-7769 U E PA RT NI E N T <br /> County SAN JOAQUIN <br /> Is Premises inside city limits Yes Census Tract: 0053.12 <br /> Mailing Address:(If different 1250 KING LOOP <br /> from TRACY,CA 95377 <br /> premises address) <br /> Type of license(s): 41 Dropping Partner: Yes No <br /> Transferor's license/name: <br /> License Tyne Transaction Tyne Master Secondary LT And Count <br /> 41-On-Sale Beer And Wine-Eating ORI Y <br /> License Type Transaction Description Fee Code Dun Date Fee <br /> Application Fee ADD PRIMARY LICENSE TYPE NA 0 02/29/24 $1,065.00 <br /> Application Fee FEDERAL FINGERPRINTS NA 1 02/29/24 $24.00 <br /> Application Fee STATE FINGERPRINTS NA 1 02/29/24 $39.00 <br /> 41-On-Sale Beer And Wine-Ea ANNUAL FEE NA 0 02/29/24 $530.00 <br /> Total $1,658.00 <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: February 29, 2024 <br /> Applicant Name(s) <br /> DRIPPIN CHICKEN INC <br /> l� <br /> 002--7 c61E) <br /> t_�M � • � S • 2 y <br /> �1 � � • � t3 � 2S�; <br /> J <br /> .,J <br /> �s c�o,r�� � <br />