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M-2015-030 <br /> Consent Agenda Form <br /> June 9, 2016 <br /> Page 3 of 3 <br /> Operator's Notarized Signature: As an authorized representative of the Operator, I hereby attest that <br /> the Operator concedes to the above described violation and agrees to comply with the Cease and Desist <br /> Order, Corrective Action, and Civil Penalty proposed in this STAFF SUMMARY FORM FOR <br /> CONSENT AGENDA ITEMS. <br /> Signed and dated this day of June, 2016. <br /> Dan Hunt for Asphalt Specialties Co. Inc. <br /> (Operator) <br /> Signature: <br /> Title: <br /> State of ) <br /> ss. <br /> County of ) <br /> The foregoing instrument was acknowledged before me this day of June, 2016, <br /> by as of Asphalt Specialties Co. Inc. <br /> Notary Public <br /> My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />