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M.1977-094 <br /> Consent Agenda Form <br /> May 5,2016 <br /> Page 3 of 3 <br /> Operator's Notarized Signature: As an authorized representative of the Permittee, I hereby attest <br /> that the Permittee concedes to the above described violation and agrees to comply with the Cease and <br /> Desist Order, Corrective Action, and Civil Penalty proposed in this STAFF SUMMARY FORM FOR <br /> CONSENT AGENDA ITEMS. <br /> Signed and dated this day of ' cap , 2016. <br /> Greg Westoff <br /> (Operator and authorized representative of Morgan Sand and Gravel Inc.) <br /> Signature: - <br /> Title: ,y <br /> State of } <br /> ) ss. <br /> County of } <br /> The foregoing instrument was acknowledged before me this !clay of Ami .2016, <br /> by as of > <br /> NORMA SINCLAIR <br /> NOTARY PUBLIC Notary Public <br /> STATE OF COLORADO <br /> NOTARY ID 20034031468 <br /> MY COMMISSION EXPIRES 3-5.2017 My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />