Laserfiche WebLink
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 /> - <br /> Signed and dated this 2 7 '! day of S0n0- -ARE2- , 2021. <br /> 6""Ot rl405-EN <br /> (Applicant) <br /> Signature: J A4 <br /> Title: jDiz J;Ee-Y "AIJ44Cp— <br /> State of ~ , I o f a,j U <br /> County of W e I j <br /> The foregoing instrument was acknowledged before me this �1 t day of 2021, <br /> by 6'0,y(h Wck 5 e In as y ti,1 ec, _ct of v►'�o• (,ons}t w c�1'J h <br /> No y Public <br /> My Commission Expires: od' 0 <br /> SIGNATURES MUST BE IN BLUE INK <br />