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Consent Agreement <br />Page 3 <br />July S, 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 , 2016. <br />Paris County <br />(Operator) <br />Signature: <br />Title: py1 A$ j <br />State of } <br />County of <br />The foregoing instrument was acknowledged before me this f .- day of 3 , 2016, <br />by-nv+�...sL as of <br />GREGORY D. KA111PAREK Notary P611c <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 20144012ftg <br />W COMMISSION EXPIRES April 1. 2020 My Commission Expires: A%e f-_ 3,Z <br />SIGNATURES MUST BE IN BLUE INK <br />