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Consent Agenda Farm M-2009-074 <br />March 27, 2017 <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 Actions, and Civil Penalty proposed in this STAFF SUMMARY FORM FOR <br />CONSENT AGENDA ITEMS. <br />Signed and dated this day of Z , 2017. <br />Operator: Colorado Backhoe Service <br />Name: (please print clearly): <br />Signature: x2 <br />Title: �rcl <br />State of 410zot <br />) ss. <br />County of <br />The foregoing instrument was acknowledged before me this 12 day of , 2017, <br />as reJ...` { ..� of Colorado Backhoe Service. <br />ANTHONY R. COLARI=LLI <br />NOTARY PUBLIC to Public <br />STATE OF COLORADO <br />NOTARY ID: 20134024864 7 <br />MY COMMISSION EXPIRES My Commission Expires: <br />SEPTEMBER 18 2017 <br />SIGNATURES MUST BE IN BLUE INK <br />