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<br />AUTHORIZATION FOR MOSQUITO 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: . _~ f~ ~~ ~ ~ C <br />ADDRESS: ~~ S~ ~~ ~ ~/'? ~ Z ~, ._ 7 ~-~~,~ ~,~; ~, <br />CITY/STATE/ZIP: I~~~l~,a~~~'~i ~~~~ ~w ~,jl~,~ ~ ~ <br />FOR CLARKE ENVIRONMENTAL MOSQUITO MANAGEMENT, INC.: <br />SIGNATURE:~~ ~~ ~~o~,~ TITLE: Control Consultant DATE: /~ f ,~C~ <br />Brian P. Deenihan <br />FOR THE CUYAHOGA COUNTY BOARD OF HEALTH: <br />~,~f ~i~~~;~lZ ~ <br />SIGNATURE' c:1. ~ `'-~~~-~ / TITLE~/,,J , ,~AFvT~4l_~,~~-~DATE.~ ~~ <br />FORTH OF WESTLAKE: <br />~~ ~ _ <br />SIGNATURh: %v~~~~ ~ ~ TITLE: ~ ~~~~ ~-~ DATE: a '~ -~ ° ~ ~j <br />FOR THE LORAIN COUNTY TH DEPARTMENT: <br />v <br />SIGNATURE:_ S~..P,C~....Q~ TITLE: ~r~Co~w~aw.=.~ DATE: ~l~(zdo~ <br />FOR THE CLEVELAND METRO PARK SYSTEM: <br />SIGNATURE: ' _h ~,, TITLE <br />FOR THE CITY F NORTH O TED: <br />~I <br />SIGNATURE. `~' (, . ~ TITLE <br />~`'LGc-6 Y~1-~t DATE:~~L~~~~ <br />/~%~r~~~ <br />DATE: W~~ `~ <br />