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Page 3 of 3 <br />Payment of the un-suspended portion of the civil penalties ($1,000) is due within 30 days of the <br />signature date of the Board Order. <br />Operator(s) Signature: <br />By signing this, the Operator agrees to the stated violation and will comply with the Cease and Desist <br />Order, Corrective Action(s) and Civil Penalty outlined above on the Staff Summary Form for Consent <br />Agenda Items. <br />Operator Signature Date Notary Public <br />My Commission expires: