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Washington County <br /> Page 3 of 3 <br /> September 18,2019 <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 /> Signed and dated this 1 day of ©I 364e j 01 <br /> (Operator <br /> Signature- <br /> Title: <br /> State of S�10 l'Cs C1 ) ' <br /> ss. <br /> County of u <br /> The foregoing instrument was acknowledged before me this day of c , <br /> by yti C��i�at-rG� as of 60p�- �- 1 <br /> Notary Public <br /> My Commission Expires: <br /> Airyse 1'. Mann <br /> SIGNATURES MUST BE IN BLUE INK NOTARY PUBLICSTATE OF COLORADO <br /> NOTARY ID 19964012722 <br /> MY Commission Expires August 10,2020 <br />