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Motorcross Consent Agreement <br /> Page 4 of 4 <br /> August23,2021 <br /> Operator's Notarized Signature: <br /> As an authorized representative of the Applicant,I herebyattest that the Operator concedesto <br /> the above described violation and agrees to comply with the Corrective Action and Civil Penalty <br /> proposed in this STAFF SUMMARY FORM FOR CONSENTAGENDA ITEMS. <br /> Signed and dated this Z3"— day of 2021. <br /> —,A.rI.., <br /> (Applicant) <br /> Si ure: <br /> Title: �ez--r ('*- , ,,JAGS-Iz <br /> State of C-CD <br /> County of k.-�--1b, _ <br /> The foregoing instrument was acknowledged before me this 2-3-rj day of 2021, <br /> by Q ccw in 'Mo 6se,-, as"p«''+ MA �f r of EM F} Cons�r�c.�inn <br /> MARY BRUSTO <br /> NOTARY PUBLIC Notary P lic <br /> STATE OF COLORADO <br /> NOTARY ID 20144044655 <br /> MY COMMISSION EXPIRES AUGUST 21 2024 <br /> My Commission Expires: b8 21 ZG 4 <br /> SIGNATURES MUST BE IN BLUE INK <br />