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Wattenberg Lakes Consent Agreement <br /> Page 3 of 3 <br /> February 9,2022 <br /> �perator'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 � ��Y t,��r f�{ ,2022. <br /> � �(.t1� ���..C,1�1 <br /> (Applicant) <br /> ,�-`..-- ��� <br /> Signature: � �-�' ' %% <br /> Title: ''-Q� I lJ��t� ��(����G�X ,�v�.�k-�(--� <br /> � <br /> State of �� ��Y cr t �.1� <br /> Countyof ���-�r5�� <br /> The foregoing instrument was acknowledged before me this�day of �'��l�t��022, <br /> by l,� .C�Gf�S ��en as i �� � of��C.�1�';!��Z ���u�{Y�o�� . G<.�i(. <br /> . ��r � <br /> SARAH GREGA cC'�C-(� �-j�L^—' <br /> NOTARY PUBLIC Notary Public <br /> STATE Of COLORADO <br /> NOTARY ID 20174007757 <br /> Mv CUMMiS1fON EXVIRES�Ef1RUARY T 1 d��l•. My Commission Expires: � � � � � <br /> SIGNATURES MUST BE IN BLUE INK <br />