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M- 2012 -048 <br />Consent Agenda Form <br />February 5, 2013 <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 Corrective <br />Action(s) and Civil Penalty outlined above on the Staff Summary Form for Consent Agenda <br />Items. <br />Operator Signature <br />Date Notary Public <br />My Commission expires: <br />