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Gladstone Consent Agreement <br /> Page 4 of 4 <br /> September 1,2020 <br /> Operator's Notarized Signature: <br /> As an authorized representative of the Applicant, I hereby attest that the Applicant concedes to <br /> the above described violation and agrees to comply with the Cease and Desist Order, Corrective <br /> Action, and Civil Penalty proposed in this STAFF SUMMARY FORM FOR CONSENT AGENDA <br /> ITEMS. <br /> Signed and dated this / day ofde° tr 2020. <br /> saes v r <br /> (Applicant) <br /> Signature: <br /> Title: fflay-a r <br /> State of (CC) 3 <br /> County of <br /> !J L <br /> The foregoing instrument was acknowledged before me this 7 day of 2020, <br /> by as � t of �tlt�0�J C���✓sloae �- <br /> N tary Public <br /> My Commission Expires: T a m 3 <br /> SIGNATURES MUST BE IN BLUE INK <br /> JESSE CHARLES STRUBLE <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20194014009 <br /> MY COMMISSION EXPIRES APRIL 12,2023 <br />