Laserfiche WebLink
11/21/2011 09:43 17195236584 <br />M-2003-019 <br />Consent Ascnda Form <br />November 18, 2011 <br />Page 3 of 3 <br />BACA COUNTY COMMISSI <br />Payment of the un- bubpended portion of the Civil penalty is due within 30 ;tans of the mailing day:: <br />of the Board Order <br />Operz.tor(e) Sign ature: <br />By si this. the Operator agrees to the stated violation and will W9aip!) with the tease and <br />Deist Order, Corrective Act and Civil Penalty vutiined above on the State' Summary Form <br />for Consent Agenda items <br />die,.....4__ 01:2,/h ti tv pi <br />• Signature Date ' otar l'ubl - <br />My Commission expires'_ 0 )L( i <br />PAGE 02 <br />r 4/4 <br />