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Holcim(US)Inc. <br /> Page 3 of 3 <br /> January 8,2020 <br /> The Board will assess a civil penalty of$100.00 per day of violation for 76 days, for a civil <br /> penalty amount of$7,600.00 with all penalties but$1,000 suspended if the Operator complies <br /> with the corrective action. <br /> If the Operator does not comply with the corrective actions set forth in the Order,then the <br /> suspended penalties, $6,600.00, shall be due and payable. Failure to submit any due and unpaid <br /> civil penalties shall result in immediate submittal of such penalties to State collections. <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 today of 6, f nz <br /> (Operator) <br /> Signature: <br /> Title: Q �r iUri� � Ti <br /> State of, caa ) <br /> _ ) ss. <br /> County of �m0(l�C ) <br /> The foregoing instrument was acknowledged before me this 14th day of `SQmQSQ 1 a1k�17, <br /> by as C-)�,.Gk;- T4 XAftQjQ1P of M 1nC . <br /> LISA ZIEGLER <br /> NOTARY PUBLIC Notary Public o0l <br /> STATE OF COLORADO <br /> NOTARY ID 20164000702 My Commission Expires: <br /> MY COMMISSION EXPIRES 01/07/2024 <br /> SIGNATURES MUST BE IN BLUE INK <br />