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M-1950-244 <br />Consent Agenda Fonn <br />May 24, 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 voluntarily consents to the above described violations and agrees to comply with the Cease <br />and Desist Order, Corrective Action, and Civil Penalty proposed in this STAFF SUMMARY FORM <br />FOR CONSENT AGENDA ITEMS. <br />Signed and dated his day of J ��..e , 2016. <br />1 <br />Operator: Cn* 1 C eek & Vi for Gold Mining Com an <br />Name: '�"' 5 (please print clearly): <br />Signature: <br />Title: ���'� a-�` •� ✓^ <br />State of C& --W-,—,4-© <br />County of <br />Te, icy - <br />ss. <br />The foregoing instrument was acknowledged before me this day o �, 2016, <br />by�Ck 1 I(M f S as " a1 of Cripple Creek & Victor <br />Gold Mining Company. <br />,nom <br />MP►R1E, V 1 <br />?�'1...• Notary Public <br />My Commission Expires: <br />•s <br />`6-ou8LIC ;. <br />SIGNATURES MUST BE IN BLUE INK <br />