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Wattenberg Lakes Consent Agreement <br /> Page 3of3 <br /> February 9,2022 <br /> Operator's Notarized Signature: <br /> As an authorized representative of the Applicant, I hereby attest that the Operator concedes to the <br /> 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 day of JY Ut&Ci,( , 2022. <br /> (Applicant) <br /> Signature: <br /> Title: <br /> Y <br /> State of <br /> County of <br /> The foregoing instrument was acknowledged before me this day of ��VUCf0022, <br /> by U2 as i _of �C,(LPCC� <br /> SARAH GREGA <br /> NOTARY PUBLIC Notary Public <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 <br /> MY(OMMISSION EXPIRES FEBRUARY 21,201', My Commission Expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />