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ACCEPTED: <br /> Outside Party <br /> Signature: <br /> Printed Name: � tr-ttlrtivkt.o...1 <br /> Title: <br /> Date: i 2,11 ?C' <br /> Address (for shipping): 2130 ILu kw„u Aoss. lt: N r' <br /> t"V v� f1 eivol AT ST: <br /> Email:rrv,,,,Q0btr cveh,#t .'1• zqt City Clerk <br /> Phone: <br /> AquaVitas, LLC Project Mana r (upon document return) <br /> Signature: <br /> Printed Name: Adam Gushgari, . ., Ph.D. <br /> Title: Chief Executive Officer <br /> Date: <br /> Address: AquaVitas, LLC <br /> 9260 E. Raintree Dr. Suite 140 <br /> Scottsdale, AZ 852607 <br /> Email: Adarn@Aquavitas.com <br /> Phone: 480-299-2471 <br /> 3 <br />