0

RI~INAL

SENDER : COMPLETE THIS SECTION

RECLERK:S

OFFI

CEIVECE

D

JAN I E 2007

STATE OF ILLINOIS

Pollution Control Board

COMPLETE THIS SECTION ON DELIVERY

0 . Received by (Name)

f

D Agent

D Addressee

C Date

1-x

of

,07

Delivery

D

. Is delivery address differen m tem 17 0

If YES, enter delivery address below:

D No

∎ Complete Items 1, 2, and 3

. Also complete

item 4 if Restricted Delivery Is desired .

•

Print yourr name and address on the reverse

ad' that We can return the card to you .

•

Attach this card to the back of the mailplece,

I

or on the front if space permits .

Article Addressed to :

PCB

2007-051

Andy Wagner

I LaSalle County Farm Supply

1 3107 N

. Illinois Rte . 23

P . 0 . Box 459

Ottawa, IL 61350

I

4. Restricted Delivery?

(Extra Fee)

PVCT-1

'P"7."Article Number

7002 2030 0004 5523 7299

(fan y n .ag{yfcb/ak3II i 3

~F6 Form 3811,

i

Februaryy12Y004

Domestic Return Receipt

102595-02-M-1540

3 .

X

Service

Gertifled

TypeMail

0 Express Mall

D

Registered

D Return Receipt for Merchandise

D Insured Mail

0 C.O.D .

0

Yes