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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greo[ness grows here. <br /> COMMERCIAL CANNABIS LICENSE APPLICATION <br /> Part A— License Type/Business Information <br /> LEGAL BUSINESS NAME: <br /> Greene Brothers Farm, Inc. <br /> BUSINESS PHYSICAL ADDRESS: CITY: STATE: ZIP CODE: <br /> 12470 Locke Road. Ste. D Lockeford CA 95237 <br /> BUSINESS MAILING ADDRESS CITY: STATE: ZIP CODE: <br /> 7513 Girard Ave. Ste. 1315 La Jolla CA 92037 <br /> APPLICATION TYPE (One application required for each license) <br /> N New Application ❑Annual Renewal ❑ Change in Operations ❑Change in License/Ownership <br /> LICENSE TYPE(Check one) <br /> Cultivation—any activity involving the planting,growing,harvesting,drying,curio radio ,or trimming of cannabis. <br /> ❑ Cultivator-Specialty Cottage-Indoor(Type 1 C-Canopy up to 500 ft2) PE 3410 <br /> ❑ Cultivator-Specialty-Indoor(Type 1A-Canopy 500 ft2-5,000 ft2) PE 3411 <br /> ❑ Cultivator-Small -Indoor(Type 2A-Canopy 5,001 ft2-10,000 ft2) PE 3412 <br /> ❑ Cultivator-Medium-Indoor(Type 3A-Canopy 10,001 ft2-22,000 ft2) PE 3413 <br /> ❑ Cultivator-Specialty Cottage-Mixed Light(Type 1 C-Canopy up to 2,500 ft2) PE 3420 <br /> ❑ Cultivator-Specialty-Mixed Light(Type 1 B-Canopy 2,501 ft2-5,000 ft2) PE 3421 <br /> ❑ Cultivator-Small-Mixed Light(Type 1B-Canopy 5,001 ft2-10,000 ft2) PE 3422 <br /> ❑ Cultivator-Medium-Mixed Light(Type 313-Canopy 10,001 ft2-22,000 ft2) PE 3423 <br /> ❑ Processor PE 3430 <br /> ❑ Nursery(Type 4)clones,immature plants,seeds PE 3435 <br /> Distribution—the procurement,sale,and transport of cannabis and cannabis products between licensees. <br /> Distributor-wholesale(Type 11-Warehouse/Transport) PE 3440 <br /> ❑ Distributor-wholesale(Type 11—Transport Only) PE 3441 <br /> ❑ Distributor-wholesale(Type 11—Transport Only Self-Distribution) PE 3442 <br /> Manufacturing—the extraction process,infusion process,packaging and labeling processes;processing,preparing,holding,and storing <br /> of cannabis products.Processing, re arin ,holding,or storing of components and ingredients. <br /> ❑ Manufacturer 1-Nonvolatile Extraction(Type 6)Uses nonvolatile solvents only(Carbon dioxide,ethanol). PE 3470 <br /> ❑ Manufacturer 2-Volatile Extraction(Type 7)Uses volatile solvents(propane,butane). PE 3471 <br /> ❑ Manufacturer-Shared Use PE 3472 <br /> Retailer—for the retail sale and delivery of cannabis or cannabis products to customers from a licensed premise. <br /> ❑ Retailer-Non-Storefront Delivery(Type 9) PE 3480 <br /> ❑ Microbusiness(Type 12)3 or More Different License Types(Select Types) <br /> PE 3490 <br /> ❑Cultivation area<10,000 square feet ❑Distributor ❑Level 1 Manufacturer ❑Non-Storefront Retailer <br /> ❑ Testing Laboratory(Type 8) PE 3495 <br /> SERVICE REQUEST ID:. S � S 4;-Z FACILITY ID:., I— 00 2 7 2 lY y <br /> PROGRAM ELEMENT CODE:I I PROGRAM RECORD ID: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/EHD <br />