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I <br />;: . <br />AUTHORIZATION FOR iV10SQUITO CONTROL <br />FOR <br />LARVAL AERIAL APPLICATIONS IN BRADLEY WOODS <br />SIGNING AND RETURNING the copy of this authorization form will authorize the <br />Clarke Environmental Mosquito Management, Inc. to perform Larval Control within the <br />stipulated limits found on this cost estimate unless otherwise stated. <br />CONTACT FOR AUTHORIZATION: <br />NAME: ? ()e <br />i <br />?DRESS: 5- s S o Or pNONE: z& - zo / - zdo r x; Z?/,/ <br />CITY/STATE/ZIT:- f l `O <br />4 <br />FOR CLARKE ENVIRONMENTAL MOSQUZTO NIANAGEMENT, INC.: <br />S IGNATURE: <br />DATE: <br />Brian P. Deenihan <br />TTTLE: Control Consultant <br />FOR THE CUYt1.HOGA COUNTY BOARD OF HEALTH: <br />SIGNATU GJ. 4-4??ZTITLE : T <br />DATE: -??--- <br />FOR THE CITY OF WESTLAKE: <br />CIGNATT tR F: ? ?4;;;?---- TITLE: /t <br />DATE:?? <br />FOR THE LORAIN COUNTY HEALTH DEPARTMENT: <br />SIGNATURE: <br />`-? - <br />D ATE: <br />FOR THE MLAArNIDD METRO PARK SYSTEM: <br />SIGNATURTITLE: <br />