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5) BILLING CONTACT if different than the permittee <br />Responsible Position (Title): Accounts Payable Supervisor <br />Held By (Person): Janet Della <br />Telephone No: 303.628.7798 <br />email address @energyfuels.com <br />Organization: Energy Fuels Resources (USA) Inc <br />Mailing Address: 225 Union Blvd, Ste. 600 <br />City: Lakewood state: Colorado Z 80228 <br />6) OTHER CONTACT TYPES (check below) Add pages if necessary: <br />Responsible Position (Title): Environmental Coordinator <br />Held By (Person): Christy Woodward <br />Telephone No: 303.628.7798 <br />email address cwoodward@energyfuels.com <br />Organization: Energy Fuels Resources (USA) Inc <br />Mailing Address: 225 Union Blvd, Ste. 600 <br />City: Lakewood <br />Pretreatment Coordinator <br />X Environmental Contact <br />Biosolids Responsible Party <br />X Inspection Facility Contact <br />Consultant <br />REQUIRED CERTIFICATION SIGNATURE [Reg 61.4(1)(h)] <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision <br />in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible <br />for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate and <br />complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine <br />and imprisonment for knowing violations." <br />Signature (Legally Responsible Party) <br />Name (printed) Harold R. Roberts <br />CHANGE OF CONTACT(s) for all PERMITS, CERTIFICATIONS, AND AUTHORIZATIONS <br />State: Colorado Zi 80228 <br />X <br />L <br />Compliance Contact <br />Stormwater MS4 Responsible Person <br />Stormwater Authorized Representative <br />Property Owner <br />Other <br />Date Are.fi ZO /L <br />Title Executive Vice President and Chief Operating Officer <br />Revised 1/2012 <br />