2024-12-09_ENFORCEMENT - M2012010 ‎(2)‎

• Permit No: M2012010
• IBM Index Class Name: Enforcement
• Doc Date: 12/9/2024
• Doc Name: Consent Agenda Summary Form
• From: DRMS
• To: Keith Woodring Las Animas County Road and Bridge Dept.
• Email Name: MAC
• Email Name: GRM
• Email Name: JLE
• Email Name: AMG
• Email Name: CMM
• Media Type: D
• Archive: No

Jolly Pit
M-2012-010
Page 3 of 3
December 9,2024
Operator's Notarized Signature:
As an authorized representative of the Applicant, I hereby attest that the Operator concedes to the above
described violation and agrees to comply with the Corrective Action and Civil Penalty proposed in this
STAFF SUMMARY FORM FOR CONSENT AGENDA ITEMS.
Signed and dated this day of , 20 .
(Operator)
Signature:
Title:
State of
County of
The foregoing instrument was acknowledged before me this day of , 20 ,
by as of
Notary Public
My Commission Expires:
SIGNATURES MUST BE IN BLUE INK