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SANJ O A Q U I N Environmental Health Department <br /> COUNTY-- <br /> H <br /> 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 /> BUSINESS LOCATION PHONE: BUSINESS LOCATION EMAIL ADDRESS: ASSESSOR'S PARCEL NUMBER: PLANNING APPLICATION NUMBER: <br /> 051-320-12 PA-2000007 <br /> LAST NAME SOLE PROPRIETORSHIP ONLY): FIRST NAME SOLE PROPRIETORSHIP ONLY): <br /> BUSINESS TITLE SOLE PROPRIETORSHIP ONLY): <br /> BUSINESS MAILING ADDRESS: I CITY: I STATE: I ZIP CODE: <br /> PHONE NUMBER: EMAIL ADDRESS: <br /> BUSINESS ENTITY STRUCTURE: <br /> X Corporation ❑ Limited Liability Company ❑ Limited Liability Partnership ❑ Limited Partnership <br /> ❑ General Partnership to <br /> Sole Proprietorship El Joint Venture El Trust <br /> El Sovereign Entity Other(specify): <br /> Is this applicant business entity a foreign ❑ Yes—Attach Foreign Corporation's Certificate of qualification issued by the California <br /> corporation? X No Secretary of State per Corporations Code,Section 2105. <br /> Is this applicant business entity a cannabis <br /> 11 Yes—Attach List of members of the cannabis cooperative association. <br /> cooperative association per Business and X No <br /> Professions Code,Chapter 22? Name of Association: <br /> DESIGNATED RESPONSIBLE PARTY <br /> DESIGNATED RESPONSIBLE PARTY LAST NAME: RESPONSIBLE PARTY FIRST NAME: I RESPONSIBLE PARTY BUSINESS TITLE: <br /> Johnson IMichelle JCFO <br /> RESPONSIBLE PARTY MAILING ADDRESS: CITY: I STATE: ZCODE <br /> 11045 Hills Ranch Rd. Mendocino I CA 195460 <br /> RESPONSIBLE PARTY RELATIONSHIP TO BUSINESS: PHONE NUMBER: t�jjohnson200@aol.com <br /> AIL ADDRESS: <br /> Owner/CEO 925 989-9636 <br /> CONTACT#1 <br /> CONTACT LAST NAME: CONTACT FIRST NAME: CONTACT BUSINESS TITLE: <br /> Greene lAaron ICEO <br /> CONTACT MAILING ADDRESS: CITY: STATE: ZIP CODE: <br /> 75 N. Main St. #223 Willits CA 195490 <br /> CONTACT RELATIONSHIP TO BUSINESS: PHONE NUMBER: I EMAIL ADDRESS: <br /> Owner/CEO 707 671-3754 Idoubleagreene@gmail.com <br /> CONTACT#2 <br /> CONTACT LAST NAME: CONTACT FIRST NAME: I CONTACT BUSINESS TITLE: <br /> Drivon IZachary jPrincipal Attorney & CEO, Drivon Coa <br /> CONTACT MAILING ADDRESS: CITY: I STATE: I ZIP CODE: <br /> 3439 Brookside Road, Ste 104 Stockton CA 195219 <br /> CONTACT RELATIONSHIP TO BUSINESS PHONE NUMBER: I EMAIL ADDRESS: <br /> General Counsel 209 636-4856 Izach@drivonconsulting.com <br /> 12/11/19 2 of 2 <br />