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M-1980-020 <br /> Consent Agenda Form <br /> January 6,2015 <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 Items. <br /> ; 17 Gam_ <br /> Opera or Signature Date N6tary Public <br /> 1- 13-ts <br /> My Commission expires: <br /> 0 <br /> 444tek <br /> ONO <br />