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SAN: JOAQUIN Environmental Health Department <br />COUNTY <br />COMMERCIAL CANNABIS LICENSE APPLICATION <br />PART B — OWNER INFORMATION <br />LEGAL BUSINESS NAME: <br />Greene Brothers Farm, Inc. <br />BUSINESS PHYSICAL ADDRESS: CITY: STATE: ZIP CODE: <br />12470 Locke Road. Ste. 600 Lockeford CA 195237 <br />OWNER INFORMATION <br />Complete the information below for each owner as defined in 4-10005(o). Total Number of Legal L5 <br />Owners: <br />OWNER # 4 of 5 <br />OWNER LEGAL LAST NAME: <br />OWNER LEGAL FIRST NAME: <br />I BUSINESS TITLE: <br />Johnson <br />I Michelle <br />F CFO <br />PHONE NUMBER: <br />EMAIL ADDRESS: <br />DATE OWNER ACQUIREDoda <br />INTEREST: <br />OF OWNERSHIP: <br />(925) 989-9636 <br />mjjohnson200@aol.com <br />4/11/22 <br />1 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 LICENSE ISSUED BY TYPE OF LICENSE ISSUED BY <br />LICENSE NUMBER LICENSE NUMBER <br />SEEATTACHED SEEATTACHED 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: <br />Code Section: <br />Type of Conviction: (felony or <br />misdemeanor) <br />Dates of Incarceration: <br />Date(s) of Probation: <br />Date(s) of Parole: <br />Date of Conviction: <br />Code Section: <br />Type of Conviction: (felony or <br />misdemeanor) <br />Date(s) of Incarceration: <br />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 />revocation <br />understand a misrepresentation of fact is cause for rejection of this application, denial of the license, or <br />of an issued license <br />OWNER SIGNATURE: DATE:04/15/26 <br />PRINT NAME: Michelle Johnson <br />SR M. FACILITY ID: ' <br />PE CODE:. PROGRAM RECORD ID: f <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 />j <br />