RECE~VED
    CLERK’S OFFICE
    FEB
    1 42005
    STATE OF ILLINOIS
    Poflution Control Board
    SENDER
    COMPLETE THIS SECTION
    COMPLETE THIS SECTiON ON
    DELIVERY
    •
    Complete items
    1, 2, and 3. Also
    complete
    item
    4 if Restricted
    Delivery is desired.
    A
    Print your name and address
    on the reverse
    so that we can
    return the card to you.
    U
    Attach this card to the
    back of thô
    mailpiece,
    or on the front if space permits.
    1.
    Article Addressed to:
    2/3/05
    B .M.
    PCB
    2005—133
    Gene Gibson
    Spoon River FS,
    Inc.
    d/b/a
    Riverland FS,
    Inc.
    1528 Knox Road 600N
    Maquon,
    IL 61458
    A.
    Signature
    ~ \~~fvt~~1
    ~
    Agent
    0
    Addressee
    ~‘B.Received by
    (
    Pt4
    nted Name)
    IC.
    Date of Delivery
    T ~
    ~
    ~ /(
    I
    ~I’
    D.
    Is delivery address different from
    item 1?
    0
    Yes
    If YES, enter delivery address below:
    0
    No
    3.
    Service Type
    ‘~-CertifiedMail
    o
    Registered
    0
    Express Mail
    0
    Return
    Receipt for
    Merchandise
    o
    Insured
    Mail
    0
    C.O.D.
    /
    2.
    Article Number
    ~Transfer
    from service label)
    7004 0750
    0004
    3960
    2632
    4.
    Restricted
    Delivery?
    (Extra Fee)
    0
    Yes
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    1 02595-02-M-1540

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