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SAN JOAQUIN <br />COUNTY <br />I (b rats++c yrrowc Lrrr <br />Environmental Health Department <br />COMMERCIAL CANNABIS LICENSE APPLICATION <br />PART B — OWNER INFORMATION <br />LEGAL BUSINESS NAME: <br />Greene Brothers Farm, Inc. <br />BUSINESS PHYSICAL ADDRESS: <br />CITY: <br />STATE: <br />ZIP CODE: <br />12470 Locke Road. Ste. 600 <br />Lockeforcl <br />CA <br />95237 <br />OWNER INFORMATION <br />Complete the information below for each owner as defined in 4-10005(o). Total Number of Legal 5 <br />Owners: <br />OWNER # 4 of 5 <br />OWNER LEGAL LAST NAME: OWNER LEGAL FIRST NAME: <br />BUSINESS TITLE: <br />Johnson I Michelle <br />CFO <br />PHONE NUMBER: <br />EMAIL ADDRESS: <br />DATE OWNER ACQUIRED <br />INTEREST: <br />% OF OWNERSHIP: <br />(925) 989-9636 <br />mjjohnson200@aol.com <br />4/11/22 <br />10.625% <br />OWNER CANNABIS FINANCIAL INTERESTS - List all state issued cannabis license(s) the owner holds an <br />or financial interest in. Attach additional. <br />-ownership <br />TYPE OF <br />LICENSE <br />LICENSE ISSUED BY TYPE OF LICENSE ISSUED BY <br />NUMBER LICENSE NUMBER <br />SEE ATTACHED <br />SEE ATTACIIED CA DCC <br />DISCLOSURES <br />Provide the information below for all convictions and attach a detailed description of the offense for which you <br />were convicted. (4-10011(a)(b)) <br />Date of Conviction: Code Section: Type of Conviction: (felony or <br />misdemeanor) <br />Dates of Incarceration: Dates of Probation: Dates of Parole: <br />Date of Conviction: Code Section: Type of Conviction: (felony or <br />misdemeanor <br />Date(s) of Incarceration: Date(s) of Probation: Date(s) of Parole: <br />OWNER ATTACHMENTS <br />® <br />1 Copy of government issued identification. <br />OWNER DECLARATIONS <br />1 1 <br />understand that I am responsible for knowing and complying with all California state and local laws and <br />regulations applicable to commercial cannabis. <br />2. 1 <br />understand I am responsible for compliance with subsequent updates to cannabis laws and regulations. <br />3 I <br />hereby declare the information contained within and attached to this application is complete, true, and <br />accurate. <br />4 I <br />understand a misrepresentation of fact is cause for rejection of this application, denial of the license, or <br />revocation of an issued license <br />OWNER SIGNATURE: M,-Che'.Ge t70G1hjOh <br />I'[^.:'.e .i':tSea ]9, 10E51:d1:51 Pig 11 <br />DATE: 9/19/2025 <br />PRINT NAME: Michelle Johnson <br />SR ID: <br />PE CODE: <br />i FACILITY ID: <br />I PROGRAM RECORD ID: <br />7-29.2019 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />