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I <br />Legal entity heport cc: Price (1) IIS. ~~~ ~ ~~~ <br />. ~ Delta (2) Mine Safety~and Health Administration <br />This report is required bylaw (30 C.F.R. 41). Form ADProved. <br />Failure to report can result in assessment of <br />a civil penalty. Knowingly making a lalse <br />statement can result in criminal prosecution ^ InlUal Notice <br />under § 1 t 0 0l the Federal Mine Safety and <br />Health Act of 1977. ®Change Notice <br />``~ <br />eD 1983 <br />.Mole: II more span is <br />reWnee m env aecli0n Mbw. <br />pease use e,eo,erne fneel <br />Date Effective 1/1/80 ,' <br />`, <br />Federal Mine Identilicatlon Number Mine Name <br />05-03119 Munger Canyon Test Site ifl <br />Mine Atldress ~' Ciry County State ZIp Code <br />Loma Garfield Colorado 81524 <br />Commodity Name of Operator <br />Coal ~Sheridan'Enterprises, Inc. <br />Person st Mlne In Charge of Hselth and Selaty <br />Name and Title ~ Address <br />Paul Osborne Drawer L <br />Mine Foreman Fruits, Colorado 81521 <br />Parson with Overall Rseponslblllty for a Health end Selsty Program et All or the Operator's Mines, 11 the Operator Ie Not Direetly <br />Involved In the Dally Operation of the Mlne <br />R:ame and Title <br />Paul Osborne <br />Mine Foreman <br />Drawer L <br />Fruits, Colorado 81521 <br />Federal Mine Identlllcatlon Numbsre of All Other Mlnee In whleh the Sole Proprietor, Partnership, Corporation, or OtMr <br />Organlution Hea a 20% or Oreatsr Ownership Interest <br />ID Numbers 3. 05-03 3 6. - - <br />1. 05-03013 4. 05-03235 7. 05-03238 10. 48-01195 <br />2. 05-03230 5. 05-03236 8. 48-01193 11. 48-01196 <br />Flrtleral Mine Identlligtlon Numbers of All Other Minas In which Any Pertnsr, Corporate Olllesr, or OtherOrgsnrxation Olliclel <br />Or Msmbar Hass 20% or Onater Ownership Interost [not eppllpble to sole proprietorship[ <br />ID Numbers <br />None <br />Address of Raeordend Telephone Number [servta o/documents upon the operator wilt W completed by melting the <br />doeumsnta to this address] <br />Name - Title Telephone Number <br />Walter Mueller, Jr. President (303) 751-0093 <br />Street Atldress - - ~ ~~" Gty State ZIp Code <br />9745 East Hampden Avenue Denver Colorado 80231 <br />Plsesa Cheek the Approprtats Box end Complete the Applleeble Seetlon <br />I. Sale Proprietorship ^ II. Partnership ®III. Corporetlan ~ IV. Other <br />I. Sots Propdetorshlp <br />Trade Name ~ Proprietor <br />Proprietor's Address (street) Clry Zip Code <br />