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2011 -11 -21 03:00 DRMS <br />M- 201)3 -019 <br />Consent Agenda Form <br />November 18, 2011 <br />Page 3 of 3 <br />Operutortws) Signature: <br />dPe <br />r Signature <br />3038328106 » 17195236584 <br />Payment of the un- suspended portion of the civil penalty is due within 30 days of the mailing data: <br />of the Board Order. <br />By signing this, the Operator agrees to the stated violation and will comp!) with the Cease and <br />Desist Order, Corrective Actions) and Civil Penalty outlined above on the Staff Sunnmary Form <br />for Consent Agenda Items. <br />Date °Jotary Public -) <br />My Commission expires:_ Q ) <br />P 4/4 <br />