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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness gro..s here. <br /> COMMERCIAL CANNABIS LICENSE APPLICATION <br /> PART B — OWNER INFORMATION <br /> L GAL BUSINESS NAME: <br /> Greene Brothers Farm, Inc. <br /> BUSINESS PHYSICAL ADDRESS: Nockeford <br /> TY: STATE: ZIP CODE: <br /> 12470 Locke Road. Ste. 600 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# 1 of 5 <br /> OWNER LEGAL LAST NAME: OWNER LEGAL FIRST NAME: BUSINESS TITLE: <br /> Daniels Patrick Chairman <br /> PHONE NUMBER: EMAIL ADDRESS: DATE OWNER ACQUIRED % OF OWNERSHIP: <br /> INTEREST: <br /> (619)405-8964 pwdaniels@mac.com 4/11/22 40% <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 /> NONE <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 /> Dates of Incarceration: Dates of Probation: Dates of Parole: <br /> Date of Conviction: Code Section: Type of Conviction: (felony or <br /> misdemeanor <br /> Dates of Incarceration: Dates of Probation: Date s of Parole: <br /> OWNER ATTACHMENTS <br /> ® Copy of government issued identification. <br /> OWNER DECLARATIONS <br /> 1 1 understand that I am responsible for knowing and complying with all California state and local laws and <br /> regulations applicable to commercial cannabis. <br /> 2. 1 understand I am responsible for compliance with subsequent updates to cannabis laws and regulations. <br /> 3 1 hereby declare the information contained within and attached to this application is complete, true, and <br /> accurate. <br /> 4 1 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: c,I/ DATE: <br /> Patrick Daniels(May 16,202212:08 PDT) <br /> PRINT NAME:Patrick Daniels <br /> SR ID: FACILITY ID: <br /> PE CODE: PROGRAM RECORD ID: <br /> 7-29-2019 <br /> 1868E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />