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Page 2 <br />Cooley Site Consent Agenda Form <br />Operator's Signature: <br />By signing this document, the Operator agrees with the stated violation, and agrees to comply with the Corrective <br />Action and Civil Penalty outlined above on the Staff Summary Form for Consent Agenda Items. <br />Operator's signature Date <br />Notary Public <br />My commission expires: <br />