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SAN JOAQUIN - COUNTY --- Environmental Health Department BUSINESS INFORMATION DESIGNATED RESPONSIBLE PARTY LAST NAME: LEGAL BUSINESS NAME: RESPONSIBLE PARTY BUSINESS TITLE: Greene Brothers Farm, Inc. IMichelle BUSINESS PHYSICAL ADDRESS: CITY: STATE: ZIP CODE: 12470 Locke Road. Ste. C Lockeford CA 95237 BUSINESS MAILING ADDRESS: CITY: STATE: ZIP CODE: 7513 Girard Ave. Ste. 1315 La Jolla CA 92037 BUSINESS LOCATION PHONE: BUSINESS LOCATION EMAIL ADDRESS: ASSESSOR'S PARCEL NUMBER: PLANNING APPLICATION NUMBER: Owner/ CFO 925-989-9636 051-320-12 PA -2000007 LAST NAME SOLE PROPRIETORSHIP ONLY): FIRST NAME SOLE PROPRIETORSHIP ONLY): CONTACT FIRST NAME: CONTACT BUSINESS TITLE: BUSINESS TITLE SOLE PROPRIETORSHIP ONLY): jAaron ICEO CONTACT MAILING ADDRESS: BUSINESS MAILING ADDRESS: CITY I STATE: ZIP CODE: 75 N. Main St. #223 Willits CA 95490 CONTACT RELATIONSHIP TO BUSINESS: PHONE NUMBER: PHONE NUMBER: EMAIL ADDRESS: Owner/CEO 707-671-3754 Idoubleagreene@gmaii.com CONTACT #2 CONTACT LAST NAME: CONTACT FIRST NAME: CONTACT BUSINESS TITLE: BUSINESS ENTITY STRUCTURE: IZachaPrincipal Attorney & CEO, Drivon Ced X Corporation ❑ Limited Liability Company STATE: ❑ Limited Liability Partnership ❑ Limited Partnership ❑ General Partnership ❑ Sole Proprietorship CONTACT RELATIONSHIP TO BUSINESS I PHONE NUMBER: ❑ Joint Venture ❑ Trust ❑ Sovereign Entity ❑ Other (specify): zach drivonconsultin .corn Is this applicant business entity a foreign corporation? X No 1:1Yes Secretary — Attach Foreign Corporation's Certificate of qualification issued by the California of State per Corporations Code, Section 2105. Is this applicant business entity a cannabis cooperative association per Business and Professions Code, Chapter 22? X No 1:1 Yes —Attach List of members of the cannabis cooperative association. Name of Association: DESIGNATED RESPONSIBLE PARTY DESIGNATED RESPONSIBLE PARTY LAST NAME: I RESPONSIBLE PARTY FIRST NAME: RESPONSIBLE PARTY BUSINESS TITLE: Johnson IMichelle jCF0 RESPONSIBLE PARTY MAILING ADDRESS: C-ITY I STATE: ZIP CODE: 11045 Hills Ranch Rd Mendocino CA 195460 RESPONSIBLE PARTY RELATIONSHIP TO BUSINESS: PHONE NUMBER: EMAIL ADDRESS: Owner/ CFO 925-989-9636 m"ohnson200 aol.com CONTACT #1 CONTACT LAST NAME: CONTACT FIRST NAME: CONTACT BUSINESS TITLE: Greene jAaron ICEO CONTACT MAILING ADDRESS: CITY: I STATE: ZIP CODE: 75 N. Main St. #223 Willits CA 95490 CONTACT RELATIONSHIP TO BUSINESS: PHONE NUMBER: EMAIL ADDRESS: Owner/CEO 707-671-3754 Idoubleagreene@gmaii.com CONTACT #2 CONTACT LAST NAME: CONTACT FIRST NAME: CONTACT BUSINESS TITLE: Drivon IZachaPrincipal Attorney & CEO, Drivon Ced CONTACT MAILING ADDRESS: CITY: STATE: ZIP CODE: 3439 Brookside Road, Suite 104 IStockton CA 195219 CONTACT RELATIONSHIP TO BUSINESS I PHONE NUMBER: I EMAIL ADDRESS: General Counsel 209 636-4856 zach drivonconsultin .corn 12111/19 2 of 2