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Conant A zenda l=orni \1-2009-074 <br /> ltai-ch 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 �-3 day of 4f�Z"e , 2017. <br /> Operator: Colorado Backh�ooe Service <br /> Name: (please print clearly): <br /> Signature: <br /> Title: <br /> State of <br /> ss. <br /> County of i� Z-6r0 ) <br /> The foregoing instrument was acknowledged before me this 12 day of 2017, <br /> as ('eS" of Colorado Backhoe Service. <br /> ANTHONY R.COLARE—LLI` �ublieNOTARY PUBLIC ta <br /> STATE OF COLORADO <br /> NOTARY ID:20134024864 1 <br /> MY COMMISSION EXPIRES My Commission Expires: �f <br /> SEPTEMBER 18 2017 <br /> SIGNATURES MUST BE IN BLUE INK <br />