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"j SAN JOAQUIN <br />Lok. COUNTY <br />. F -x <br />Fn Grr:�l:.uss brows brre <br />Environmental Health Department <br />COMMERCIAL CANNABIS LICENSE APPLICATION <br />PART B — OWNER INFORMATION <br />LEGAL BUSINESS NAME: <br />Greene Brothers Farm, Inc. <br />OWNER LEGAL LAST NAME: <br />BUSINESS PHYSICAL ADDRESS: <br />12470 Locke Road. Ste. 600 <br />CITY: <br />Lockeford <br />STATE: ZIP CODE: <br />CA 95237 <br />I Patrick <br />I Chairman <br />PHONE NUMBER: <br />OWNER INFORMATION <br />DATE OWNER ACQUIRED <br />INTEREST: <br />Complete the information below for each owner as defined in 4-10005(o). <br />(619) 405-8964 <br />Total Number of Legal 5 <br />Owners: <br />OWNER # 1 of 5 <br />OWNER LEGAL LAST NAME: <br />OWNER LEGAL FIRST NAME: <br />BUSINESS TITLE: <br />Daniels <br />I Patrick <br />I Chairman <br />PHONE NUMBER: <br />EMAIL ADDRESS: <br />DATE OWNER ACQUIRED <br />INTEREST: <br />% OF OWNERSHIP: <br />(619) 405-8964 <br />pwdaniels@mac.com <br />4/11/22 <br />40% <br />OWNER CANNABIS FINANCIAL INTERESTS - List all state issued cannabis license(s) the owner holds an <br />ownership or financial interest in. Attach additional. <br />TYPE OF LICENSE ISSUED BY <br />LICENSE NUMBER <br />TYPE OF <br />LICENSE <br />LICENSE ISSUED BY <br />NUMBER <br />See Attached <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: <br />Type of Conviction: (felony or <br />misdemeanor) <br />Date(s) of Incarceration: Date(s) of Probation: <br />Date(s) of Parole: <br />Date of Conviction: Code Section: <br />Type of Conviction: (felony or <br />misdemeanor <br />Date(s) of Incarceration: Date(s) of Probation: <br />Date(s) of Parole: <br />OWNER ATTACHMENTS <br />® <br />Copy of government issued identification. <br />OWNER DECLARATIONS <br />1 1 <br />regulations <br />understand that I am responsible for knowing and complying with all California state and local laws and <br />applicable to commercial cannabis. <br />2. 11 <br />understand I am responsible for compliance with subsequent updates to cannabis laws and regulations. <br />3 1 <br />hereby declare the information contained within and attached to this application is complete, true, and <br />accurate. <br />4 1 <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: wpr.�Q <br />7'1I'CK Cdr(,:pr 22. 21126 16 io 07 PD") <br />DATE: 04/22/26 <br />PRINT NAME: Patrick Daniels u <br />SR ID: <br />i <br />P CODE:: <br />FACILITY ID: <br />PROGRAM RECORD ID: <br />7-29-2019 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br />