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5/12/2021 MSHA- RECEIVE® <br /> Legal Identity Report (2000-7) <br /> JUL 19 2022 <br /> DIVISION OF RECLAMATION <br /> Confirmation information <br /> '['be E-Document Number for this submission is#2969351. This number is your confirmation that MSHA has received <br /> your filing. <br /> This form has been submitted to MSHA,district Denver District(M6000). <br /> Please print a copy of this form for your records. <br /> Mine Information <br /> Mine ID 05-04948 <br /> Mine Name Portable Unit#3 <br /> Mine Location Address 270 South 15th Street <br /> Canon CitN. CO 81212 <br /> Mine Location County Fremont <br /> Directions to Mine Colorado(30 miles west <br /> of Canon City. South on <br /> F{NNy 69 30 miles, left on <br /> Lake Deweese Road). <br /> Ro,,al Gorge Pit, 8 Miles <br /> West of Canon City, <br /> Phone Number of Mine (719) 275-6894 <br /> Mine Operator Name Colorado Quarries lnc <br /> Mine Operator 270 South 15th Street <br /> Address Canon Citv,CO 81212 <br /> Type of Commodity Stone <br /> (product) <br /> Type of Operation Surface <br /> Mine Health and Safety Information <br /> Person at Mine in Charge of Health and Safety <br /> Name Aaron Tezak <br /> Title Vice President <br /> Email Address aaron't-ecoloradoquarries.cotn <br /> Address 270 South 15th Street <br /> Canon City, CO 81212 <br /> Person at Mine in Charge of ALL Health and Safety <br /> Name Nicole Martin <br /> Title Secretary/Treasurer <br /> Email Address nicole(ct,coloradoquarries.com <br /> Address 270 South 15th Street <br /> Canon Cit%. CO 81212 <br /> Address of Record <br /> 1/2 <br />