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Motorcross Revised Consent Agreement <br /> Page 4 of 4 <br /> September 27,2021 <br /> Operator's Notarized Signature: <br /> As an authorized representative of the Applicant, I hereby attest that the Operator concedes to <br /> the above described violation and agrees to comply with the Corrective Action and Civil Penalty <br /> proposed in this STAFF SUMMARY FORM FOR CONSENT AGENDA ITEMS. <br /> Signed and dated this 3 TM°_" day of V6Us 1 , 2021. <br /> (--:;,AV(0 I~ l AISETJ <br /> (Applicant) <br /> Signatur <br /> Title: A rXW VC- <br /> State of CO <br /> County of ( o-l'> <br /> The foregoing instrument was acknowledged before me this ,Day of 2021, <br /> by��aki as-�Lo of rn G C®hSTr 4 ac�::- <br /> Not y Publ' <br /> PE NY R. LYNN <br /> NOTA;Y i�jxic <br /> STATE Of cOLGRADG <br /> NOTARY ID?�t04^43613 My Commission Expires: <br /> [MYCOMAMISSION EXPIRES OCTCOER 14,2022 <br /> SIGNATURES MUST BE IN BLUE INK <br />