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COLORADO DEPARTMENT OF PUBLIC <br />HEALTH AND ENVIRONMENT <br />Water Quality Control Division <br />4300 Cherry Creek Drive South B2 Permits <br />Denver, Colorado 80246 -1530 <br />STATE OF COLORADO <br />Colorado Department <br />of Public Health <br />and Environment <br />For Agency Use Only <br />Date Received / / <br />Effective Date / / <br />CHANGE OF CONTACT(s) for all PERMITS, CERTIFICATIONS, <br />AND AUTHORIZATIONS <br />This form must be submitted for changes made to any of the contacts or information listed below. <br />PHOTO COPIES, FAXED COPIES, PDF COPIES OR EMAILS WILL NOT BE ACCEPTED. <br />PERMIT, CERTIFICATION, OR AUTHORIZATION NUMBER COR 040223 (This number does not end in 0000) <br />(A separate form must be prepared for each Permit, Certification, or Authorization covered by these changes.) <br />PERMITTEE (If more than one please add additional pages) <br />ORGANIZATION FORMAL NAME: Energy Fuels Resources (USA) Corp <br />The legally responsible organization is either the owner or operator of the facility or project to which the <br />permit has been issued, or both if designated as co- permittees by the Division. <br />FACILITY NAME Sunday Complex Mines <br />ENTER ALL OF THE INFORMATION FOR EACH CONTACT WHERE THERE IS A CHANGE. <br />1) PERMITTEE the person authorized to sign and certify the permit application. This person receives all <br />permit correspondences and is legally responsible for compliance with the permit. <br />Responsible Position (Title): Executive Vice President and Chief Operating Officer <br />Held By (Person): Harold R. Roberts <br />Telephone No: 303.628.7798 <br />email address hroberts @energyfuels.com <br />Organization: Energy Fuels Resources (USA) Inc <br />Mailing Address: 225 Union Blvd, Ste 600 <br />City: Lakewood State: Colorado Z ip: 80228 <br />This form must be signed by the Permittee to be considered complete. <br />Per Regulation 61 In all cases, it shall be signed as follows: <br />a) In the case of corporations, by a responsible corporate officer. For the purposes of this section, the responsible corporate <br />officer is responsible for the overall operation of the facility from which the discharge described in the application <br />originates. <br />b) In the case of a partnership, by a general partner. <br />c) In the case of a sole proprietorship, by the proprietor. <br />d) In the case of a municipal, state, or other public facility, by either a principal executive officer or ranking elected official <br />Revised 1/2012 <br />