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Consent Agreement <br /> Page 3 <br /> July 8, 2016 <br /> Operator's Notarized Signature: As an authorized representative of the Operator, I hereby attest <br /> that the Operator concedes to the above described violation and agrees to comply with the Cease and <br /> Desist Order, Corrective Action, and Civil Penalty proposed in the STAFF SUMMARY FORM FOR <br /> CONSENT AGENDA ITEMS. <br /> Signed and dated this day of 12016. <br /> Park County <br /> (Operator) <br /> Signature: <br /> Title: <br /> State of ) <br /> County of ) <br /> The foregoing instrument was acknowledged before me this day of , 2016, <br /> by as of <br /> Notary Public <br /> My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />