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Phillips County <br /> Page 3 of 3 <br /> September 23,2019 <br /> Operator's Notarized Signature: As an authorized representative of the Operator, I hereby <br /> attest that the Operator concedes to the above described violation and agrees to comply with the <br /> Cease and Desist Order, Corrective Action, and Civil Penalty proposed in this STAFF <br /> SUMMARY FORM FOR CONSENT AGENDA ITEMS. <br /> Sign and dated this day of <br /> (Operat <br /> Signat <br /> Title: <br /> State of L0 1040 eta ) <br /> ss. <br /> County of j j ) <br /> The foregoing instrument was acknowledged before me this 3D day of Sp -cti^b�v�- Zola <br /> bY �/ -�-�5 ✓ as .L/�/�/�` 7.PiF 7CDe of {J/� <br /> T <br /> TOBYATHOMPSON Notary Public�A-�` <br /> NOTARY PUBLIC <br /> STATE OF COLORA 9 M Commission Expires: <br /> NOTARY ID 20074037598 Y p <br /> MY COMMISSION EXPIRES OCTOBER 4,2019 <br /> SIGNATURES MUST BE IN BLUE INK <br />