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-~ ---.- . <br />Legal Identity Report U.S. Department of Labor ~_` <br />Mine Salety and Health Administration ,",,, <br />This report is required by law 13D C.F.R. 411. Failure to report can result Forin Approvetl: OMB No. 1219-0008 Expires Jan 31, 1997 <br />in assessment of a civil penalty. Knowin y making a false statement can <br />rtsult in criminal prosecution under §11~pf the Federal Mine Safety end <br />Hmlth Act of 1977. This report should fplp prepared only by en official ~ Initial Notice Effective Date of Changes <br />with full knowledge of ownership infoml~tlon. Thu report must t>e sign- <br />al, whve indloeted by arrow, to be velWy ,TYpo or Wlnt In Ink only. <br />Noa: If more space Is required In any section below, use a separate sheet. ®Update Notice November 1989 r, <br />1. Federal Mine Identifi®tion Number ' 2. Mine Name Ito be used for all u ~~ <br />INew I.D. r p y Pdate notions) 3. Directions to the Mine (mileagedirection from <br />equired for new o eralion onl 1 nearest town, city, and landmark) <br />05-03793 Twin Pines No 2 Mine 1~ miles SW of Rockvale on Co tnty Rd 78 <br />4. Mine Location Address 5. City 6. County 7. State 8. Zip Code ~ , <br />P. O. Box 2059 .Canon City Fremont Colorado 81212 <br />9. Official Business Name of Operator ~' 10. Telephone Number in 1'. Commodity (type of product & opere- <br />Twin Fines Investment Limited Parnerefiip Emergency /ion-surface, underground or facility) . <br />Falcon Ener¢v. Inc..'. General Partner 303-784-3361 Underprround Coal Mine <br />Parson at Mine in Charge of Haalth and S~fity (Superintendent or Principal Ollicer) <br />ame and Title -~ 13. Address <br />Joseph Carpine, Minti'~Manager P. O. Box 2059, Canon City, Colorado 81212 <br />Psnon with Overall Responsibility for s f1aelth and Safety Program et All of the Operator's Mines, if the Operator is Not Directly Involved in the <br />Daily Operation of the Mine. (Salary Dlreetor/ <br />74. Name and Title 15. Address <br />N /A <br />Federal Mina Identification Numbers of All Other Mines in which the Sole Proprietor, Partnership, Corporation or Other Organization has a 20% <br />or Greater Ownership Interest. <br />N /A <br />Federal Mine Identifination Numbers of pll Other Mines in which Any Partner, Corporate ONitar, Other Organization Official or Member has a <br />20% or Greeter Ownership Interest Inot ~plirable to sole propriatorshipl . <br />None <br />Address of Records and Telephone Number (Service of documents upon the operator wi/l ba completed by mailing or personal service o! the docu- <br />ments to thir sddreu. /! P.O. Box or Genpra/ Delivery is used Ior mei/!ng address, a separate street addnsss for persona/ service must 6e prorided.l ' <br />18. Name of Person to Receive Official Meil or Service Title 19. Telephone Number <br />Roger M. Breyfogle Registered Agent 303-275-8683 <br />20. Street Address -, 21. City 22. State 23. Zip Code <br />303 North Seventh Street Canon City Colorado 81212 <br />2lllal. man Address Z1lal. City 221a1. State 23(al. Zip Code <br />Same as above <br />24. Please Check the Appropriate Box an4 Complete the Applicable Section (check only one boxl <br />I. Sole Proprietorship II. Partnership ~ III. Corporation ~ IV. Other <br />-. <br />}. <br />Section I. Sala Proprietorship ~ <br />1. Trade Nama of Company ' : } ~ 2. Proprietor's Nema and Address of Residence <br />;; <br />3. Proprietor's Principal Office Address (etteetl 4. City 5. State B. Zip Code <br />1.. qF <br />1, <br />i <br />i I <br />~'I <br />i 'h <br />fiectidn II. Partnership <br />