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M2002-120 <br /> Consent Agenda Form <br /> April 11, 2019 <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 / \ , 2019. <br /> Mark Johnson <br /> (Authorized representative of Bestway Concrete and Aggregate) <br /> Signature: <br /> Title: <br /> State of cj6K-(i_Ab ) <br /> ss. <br /> County of L�-a2 Q ) <br /> The foregoing instrument was acknowledged before me this J day of l _ , 2019, <br /> by V " ICE"� as of Cyr-O <br /> ►� <br /> SANDRA K JOSEPH Notary Public <br /> Notary Public—State of Colorado <br /> Notary ID 20074024190 <br /> My Commission Expires Nov 21,2ort My Commission Expires: // a?/ -2/ <br /> SIGNATURES MUST BE IN BLUE INK <br />