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M- 2003 -019 <br />Consent Agenda Form <br />September 22, 2011 <br />Page 3 of 3 <br />Operator(s) Signature: <br />By signing this, the Operator agrees to the stated violation and will comply with the Cease and <br />Desist Order, Corrective Action(s) and Civil Penalty outlined above on the Staff Summary Form <br />for Consent Agenda Items. <br />Operator Signature <br />Date Notary Public <br />My Commission expires: <br />