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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 AJJ UTHORIZATION: <br />NAME: . ,~ ~ l~ ~ ~ t L l.°~~' L <br />ADDRESS: ~ .~ ~ C~r'?2? ~~'/~' ~~ PHONE: Z l~ - 7 ~ ~/.- ~ ~~: ~~ <br />CITY/STATE/ZIP: ~~~'!r~'~"li` , (,~~ ~`-~% L~~~~ S ,~~ <br />FOR CLARKE ENVIRONMENTAL MOSQUITO MANAGEMENT, INC.: <br />SIGNATURE:~,~ ~~ ~~~~.~ TITLE: Control Consultant DATE: ~6,~C~ <br />Brian P. Deenihan <br />FOR THE CUYAHOGA COUNTY BOARD OF HEALTH: <br />t ~.i/~~ f'EC % U1~ <br />SIGNATU ~ ~'"t "`__ ~~ ~/ TITLES/,J2nl~i1~~/i.~11_i~~r~DATE.~ ~~' <br />FOR TH OF WESTLAKE: <br />~y,~ j~~~~~ <br />SIGNATUR~,~~ /dl ~~ ~ TITLE: ~~ ~~~ -ti DATE: ~ '~ -~ ~ ~~~ <br />FOR THE LORAIN COUNTY TH DEPARTMENT: <br />v <br />SIGNATURE: _ 5~-P,~..~-ems TITLE: ~r !~C''rw•~+•--+ DATE: g~~lzoo~ <br />FOR THE CLEVELAND METRO PARK SYSTEM: <br />SIGNATURE: <br />FOR THE CITY <br />SIGNATURE' <br />TITLE: ~t~Gc.,y J~ DATE:~~ /~c~. <br />TITLE <br />4-~ <br />/r~r~~, <br />DATE:~~~~~ <br />