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egal identity Report <br />cc : Price (1) U.S. Department of Labor <br />Delta (2) <br />Mine Safety and Health Administration <br />This report is required bylaw (30 C.F.R. 41). <br />Failure to report can result in assessment of <br />a civil penalty. Knowingly making a false <br />statement can result in criminal prosecution <br />under § 110 of the Federal Mine Safety antl <br />Health Act of 1977. <br />Federal Mine Identification Number Mine Name <br />Form Approved. OMB No. 44-R1677 <br />Initial Notice <br />Q Change Notice <br />\`~~ <br />res Sep 1983 <br />~ repurtep m any ceceon below. <br />please uae a xunu sneel. <br />Date Effective 1/1/80,,~~ <br />05-03013 McClave Canyon Test Site ~1 <br />Mino Address Ciry County State Zip Code <br />Loma Garfield Colorado 81524 <br />Commodity Name of Operator <br />Coa 1 •'.Sheri den=. EPterpr ses_~ InG_ <br />Peron et Mine In Charge of Naalth end Safety <br />Narne and Title Address <br />Paul Osborne Drawer L <br />Mine Foreman Fruita, Colorado 81521 <br />Person with Overoli Reaponsibllity for a Health end Safety Prognm et All of the Operotore Mines, If the Operator is Not Dlroctly <br />Involved In the Deily Operation of the Mine <br />Name and Title <br />Paul Osborne <br />J+li vie Foreman <br />Drawer L <br />Fruita, Colorado 81521 <br />Federal Mine Idenlilleatlon Numbers of All Other Mines In which the Sole Proprietor, Pertnerohip, Corporotlon, or Other <br />Organi>atlon Hse a 20% or Greater Ownarohlp Interoat <br />ID Numbers 3. 05-0 - <br />1. 05-03119 4. 05-03235 7. 05-03238 10. 48-01195 <br />2. 05-03230 5. 05-03236 8. 48-01193 11. 48-01196 <br />Federal Mine Idantlfteatlon Number of All Other Mlnsa In which Any Partner, Corporate Officer, or Other OrganrraNOn OtNeiel <br />Or Member Hes a 20 % or Groater Ownership Intsreet (not spplleable to sole proprlatorohlpJ <br />ID Numbers <br />None <br />Address of Record and Telephone Number (asnlca of documents upon the opsrotor will be completed by mailing the <br />doeumenta to thla etldroasJ <br />Name Title Telephone Number <br />Walter Mueller, Jr. President (303) 751-0093 <br />Street Atldress City <br />9745 East Hampden Avenue Denver Colorado 80231 <br />Plsesa Check the Appropriate Bo: end Complete the Applicable Section <br />I. Sole Proprietorship ^ ff. Partnership ®III. Corporation ~ IV. Other <br />1. Sole Proprletorohlp <br />Traoe Name Proprie[or <br />C~ <br />Proprietor's Adtlress (street) Ciry Zip Cotle <br />