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Ni1-1978-208 <br /> Consent Auenda Form <br /> .'anuary 10, 2019 <br /> Paige 3 of 3 <br /> Operator's Notarized Signature: As an authorized representative of the Operator, I hereby attest that the <br /> Operator agrees to compl ith the conditions proposed in this STAFF SUMMARY FORM FOR CONSENT <br /> AGENDA ITEMS. <br /> Signed and dated t i day of JanuaD ,, 2019. <br /> Elk Creek Sand a v LLC <br /> (Operator) <br /> Signature: <br /> I <br /> Title: --- <br /> Stag of ) <br /> � ) ss. <br /> County o ) <br /> The forego ing�tr ment was acknowledged before me this IV—" day of January, 2019, <br /> bj)j (A- V_, as WtU � of Elk Creek Sand and Gray_el, LLC. <br /> t - <br /> LINDA BRABAND <br /> NOTARY PUBLIC-STATE OF COLORADO N tary Public <br /> NOTARY ID 19994002051 <br /> MY COMMISSION EXPIRES NOV 15, 2022 My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />