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N41983-090 <br /> Consent Agenda Form <br /> March 23, 2017 <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 vv�,�2s , 2017. <br /> Mark Johnson <br /> (Authorized representative of Bestway Concrete and Aggregate) <br /> Signature: A� <br /> Title: <br /> State of <br /> ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this� day of /' ' 2017, <br /> by as (� o VLZTLs��eJar�, <br /> v►cF<i cruzAr� d Notary Public <br /> NOTARY PUBUC <br /> STATE OF COLORADO <br /> NOTARY ID 20114024401 <br /> 1 UY GOMM15S{ON EXPIRES APRIL 22,2019 , My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />