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M-1980-244 <br />Consent Agenda Form <br />April 11, 2018 <br />Page 3 of 3 <br />of the effective date of the Board Order. If the Operator does not comply with the corrective <br />actions set forth in the Order, then the suspended penalties, $97,500, shall be due and payable. <br />Failure to submit any due and unpaid civil penalties shall result in immediate submittal of such <br />penalties to State collections. <br />Operator's Notarized Signature: As an authorized representative of the Operator, I hereby attest that <br />the Operator voluntarily consents to the above described violations and agrees to comply with the Cease <br />and Desist Order, Corrective Action, and Civil Penalty proposed in this STAFF SUMMARY FORM <br />FOR CONSENT AGENDA ITEMS. <br />Signed and dated this _ day of 12018. <br />Operator: Crinole Creek & Victor Gold Mining Company <br />Name: <br />Signature: <br />Title: _ _ � '� cam. ( i. V� U k <br />State of —0,-)k0(a ct o <br />i ) ss. <br />County of \� ) <br />(please print clearly): <br />The foregoing instrument was acknowledged before me this <br />h <br />day of - 1 , 2018, <br />by <br />as <br />of Cripple Creek & Victor Gold Mining Company <br />r <br />F <br />MARIE ROBERTS <br />c - State of Colorado Notary P lic <br />D 20124056346 <br />on Expires Oct 3, 2020 My Commission Expires: �b (� CX7�,- C> <br />SIGNATURES MUST BE IN BLUE INK <br />