A. Each application for a license shall be submitted by the person who will be the licensed operator of the mine. No application for a license or a renewal thereof is complete unless it contains the following:
1. The identity of the applicant. The applicant shall state (i) the name and address of the mine and its federal mine identification number, (ii) the name and address of the person with overall responsibility for operating decisions at the mine, (iii) the name and address of the person with overall responsibility for health and safety at the mine, and (iv) the federal mine identification number of every other mine in which the applicant has a 20 percent or greater ownership interest;
2. If the applicant is a sole proprietorship, in addition to the information required by subdivision 1, (i) his full name and address and (ii) the trade name, if any, and the full name, address of record, and telephone number of the proprietorship;
3. If the applicant is a partnership, in addition to the information required by subdivision 1, (i) the full name and address of each partner; (ii) the trade name, if any, and the full name and address of record and telephone number of the partnership; and (iii) the federal mine identification number of every other mine in which any partner has a 20 percent or greater ownership interest;
4. If the applicant is a corporation, in addition to the information required by subdivision 1, (i) the full name, address of record, and telephone number of the corporation and the state of incorporation; (ii) the full name and address of each officer and director of the corporation; (iii) the full name, address, and state of incorporation of the parent corporation if the corporation is a subsidiary corporation; and (iv) the federal mine identification numbers of every other mine in which any corporate officer has a 20 percent or greater ownership interest;
5. If the applicant is any organization other than a sole proprietorship, partnership, or corporation, in addition to the information required by subdivision 1, (i) the nature and type, or legal identity, of the organization; (ii) the full name, address of record, and telephone number of the organization; (iii) the name and address of each individual who has an ownership interest in the organization; (iv) the name and address of the principal organization officials or members; and (v) the federal mine identification number of every other mine in which any official or member has a 20 percent or greater ownership interest;
6. The name and address of any agent of the applicant with responsibility for the business operation of the mine, and any person with an ownership or leasehold interest in the minerals to be mined;
7. The following information about each independent contractor working at the mine: (i) the independent contractor’s trade name, business address, and business telephone number; (ii) a description of the nature of the work to be performed by the independent contractor and where at the mine the work is to be performed; (iii) the independent contractor’s MSHA identification number, if any; (iv) the independent contractor’s address of record for service of citations and other documents; (v) the names and addresses of persons with overall responsibility for operating decisions; and (vi) the names and addresses of persons with overall responsibility for the health and safety of employees;
8. The names and addresses of persons to be contacted in the event of an accident or other emergency at the mine;
9. Any information required by the Department that is relevant to an assessment of the safety and health risks likely to be associated with the operation of the mine; and
10. For any license renewal, the annual report required pursuant to § 45.2-1129.
B. The application shall be certified as being complete and accurate by the applicant, if an individual; by the agent of a corporate applicant; or by a general partner of an applicant that is a partnership. The application shall be submitted on forms furnished or approved by the Department.
C. Within 30 days after the occurrence of any change in the information required by subsection A, the licensed operator shall notify the Department in writing of such change.