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M- 2009 -027 <br />Consent Agenda Form <br />August 15, 2013 <br />Page 3 of 3 <br />Operator(s) Signature: <br />By signing this, the Operator agrees to the stated violation and will comply with the Corrective <br />Action(s) and Civil Penalty outlined above on the Staff Summary Form for Consent Agenda <br />Items. <br />Operator Siluature Date 7 <br />I", j /i�C <br />Notary Public <br />My Commission expires: b - Q <br />BERNADINE L. MEDINA <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID # 20054033904 <br />MY COMMISSION EXPIRES AUGUST 29, 2017 <br />