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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 <br />3021 REYNOLDS RANCH PKWY <br />STE 150 <br />LODI, CA 95240 <br />(209) 371-6761 <br />DISTRICT SERVING LOCATION: LODI <br />File Number: 667821 <br />Receipt Number: 2982913 <br />Geographical Code: 3905 <br />Copies Mailed Date: March 24, 2025 <br />Issued Date: <br />First Owner: <br />Name of Business: <br />Location of Business: <br />County <br />Is Premises inside city limits <br />Mailing Address:(If different <br />from <br />premises address) <br />Type of license(s): <br />Transferor's license/name: <br />GREEN FROG LIQUOR & GROCERY INC <br />GREEN FROG LIQUOR & GROCERY <br />567 W FREMONT ST <br />STOCKTON, CA 95203-2828 <br />SAN JOAQUIN <br />Yes Census Tract: 0003.00 <br />21 <br /> Dropping Partner: Yes No <br />579844 / QAHTAN, HAMDAN MOHAMMED TAHER <br />License Type Transaction Type Master Secondary LT And Count <br /> <br />21 - Off-Sale General PER <br />License Type Transaction Description Fee Code 17,ta Date Fee <br />Application Fee PERSON TO PERSON TRF NA 0 03/24/25 $1,525.00 <br />Application Fee FEDERAL FINGERPRINTS NA 2 03/24/25 $48.00 <br />Application Fee STATE FINGERPRINTS NA 2 03/24/25 $78.00 <br />21 - Off-Sale General ANNUAL FEE NA 0 03/24/25 $984.00 <br />Total $2,635.00 <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: March 24, 2025 <br />Applicant Name(s) <br />GREEN FROG LIQUOR & GROCERY INC <br />IN 0 S 21 0145