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San Joaquin County Agricultural Commissioner New Restricted Material Permit/OP ID Applicants Questionnaire* RETURN THIS FORM TO: Circle your District Email: stocktonag2@sjgov.org (if known) Stockton Office: 2101 E Earhart Ave, Stockton, Ca, 95206 A D I Phone Number: (209)953-6000 Fax: (209)953-6022 E F G Lodi Office: 10 W Locust Ave, Lodi, Ca, 95240 C S Phone Number: (209)331-7287 Fax: (209)331-7288 Simms Office: 17620 E HWY 120, Ripon, Ca, 95366 Phone Number: (209)468-5542 Fax: (209)468-5544 Date of Request: Business or Ranch Name: 5/8/23 Greene Brothers Farm, Inc Permit Applicant's First and Last Name: Business Address: Aaron Greene 12470 Locke Rd, Lockeford, Home Phone Cell: Business: Fax: N/A Email: 24 Hour Emergency Contact Number: Name and Number: (707) 671-3754 (707) 671-3754 doubleagreene@gmail.com (707) 671-3754 Mark Greene: (707)972-0011 QAL/QAC/PAC license holder: Name(s)? License Number(s)? Aaron Greene; Mark Greene, Michelle Greene CCL22-0001146 (State); SJ County CCL TBD: ( ) Additional Contacts to be added to permit: Gaby Bronsztein; Yoshi Sakashita Do you have a pesticide dealer? If so, their name(s)? Do you have a Pest Control Advisor (PCA)? If so, their name? No. No. Do you have employees? Ix ❑ No If yes, are they: X ❑ Pesticide Handlers ❑ Fieldworkers ❑ Neither NOTICE: If you do not own a site that you intend to add to your permit you will be required to provide a letter of authorization, lease agreement, or other documentation from the property owner/operator clearly stating that you are their authorized representative in obtaining a Restricted Materials permit (RMP)/Operator Identification Number (Op Id) for that site as defined in Section 6000 of the California Code of Regulations before that site can added to your RMP/Op Id. Location of each property (site) to be treated? Include all known sensitive areas that could be adversely impacted by the use of restricted materials and the measures that will be used to mitigate potential impact. (Use the back of this page if more room and/or a map is needed) 12470 Locke Road Lockeford, CA 95237 (APN:051-320-12) Commodity(s)/Crop(s) to be treated including acreage: (Use the back of this page is more room is needed) Cannabis: <22,000sf Anticipated pest problem(s) for each crop (pest(s) to be controlled): Mites, Aphids etc... Anticipated restricted use material(s) for each crop (pest(s) to be controlled: N/A. All amendments to be used are fully organic, CA approved Comments: (Use the back of this page if more space is needed) peant � nature: Aaron GreknAay 8, 2023 14:39 PDT) *Excluding email addresses and telephone numbers, information on Restricted Material Permits and Operator Identification Numbers is considered public record.