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M 2002-120 <br /> Consent Agenda Form <br /> April 1 1, 2019 <br /> Page 3 of 3 <br /> T <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 ;L uk day of 92019. <br /> Mark Johnson <br /> (Authorized representative of Bestway Concrete and Aggregate) <br /> Signature: V\Ik" <br /> /Title: LrnC,- <br /> State of Cjff-C�Ab <br /> ) <br /> ss. <br /> County of LL--.e Q ) <br /> The foregoing instrument was acknowledged before me this- /J 7-1k day of 4 - 1 , 2019, <br /> by V " IC�r� a✓ &rsti 1 as f '' Mace-r of <br /> — — — — — — — — — — kl0e,� <br /> SANDRA K JOSEPH Notary Public <br /> Notary Public—State of Colorado <br /> Notary ID 20074024190 <br /> My Commission Expires Nov 21,2021 My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />