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2011 -11 -21 03:00 DRMS 3038328106 >> 17195236584 P 4/4 <br />M- 2003 -019 <br />Consent Agenda Form <br />November 18, 2011 <br />Page 3 of 3 <br />Payment of the un- suspended portion of the civ penalty i3 due w --thin 30 :lays of the [nailing dat <br />of the Board Order. <br />Operator(s) Signature: <br />By Signing this, the Operator agrees to the stated violation and will <:onrply wit) th4 Cerise and <br />Desist Order, Corrective Action(s) and Civil Penalty oartlwed above on the staff Sunimary Forth <br />for Consent Agenda Items. <br />e i r Signature } <br />� � D ate \I�it;ea a l a� •I — � <br />My Commission expires; <br />