Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br />CC1u ,y <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 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 # 5 of 5 <br />OWNER LEGAL LAST NAME: <br />OWNER LEGAL FIRST NAME: <br />BUSINESS TITLE: <br />Greene <br />Mark <br />I C00 <br />PHONE NUMBER: <br />EMAIL ADDRESS: <br />DATE OWNER ACQUIRED <br />INTEREST: <br />% OF OWNERSHIP: <br />(707) 972-0011 <br />tahoemark6l@gmail.com <br />4/11/22 <br />19.6875% <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 TYPE OF LICENSE ISSUED BY <br />LICENSE NUMBER LICENSE NUMBER <br />SEE ATTACHED SEE ATTACHED 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 />4/8/2003 CVC 23103(a) Misdemeanor <br />Dates of Incarceration: Dates of Probation: Dates of Parole: <br />N/A N/A N/A <br />Date of Conviction: Code Section: Type of Conviction: (felony or <br />misdemeanor) <br />1/30/2008 231520 Misdemeanor <br />Dates of Incarceration: Dates of Probation: Date(s) of Parole: <br />N/A N/A N/A <br />OWNER ATTACHMENTS <br />® <br />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 />re ulations applicable to commercial cannabis. <br />2. 1 <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: d�� <br />t•ar. (5cq 19,21;522:35:75 PD j <br />DATE: 9/19/25 <br />PRINT NAME: Mark Greene <br />SR ID: <br />PE 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 />