1. Page 1
 
RECEIVED
CLERK'S
OFFICE
AUG 2
7
2008
STATE OF ILLINOIS
Pollution Control
Board
SENDER: COMPLETE
THIS SECTION
■
Complete items 1, 2, and
3. Also complete
item 4 If Restricted Delivery is desired.
■
Print your name and address on the reverse
so that we can return the card to you.
■
Attach this card to the back of the mailpiece,
or on the front if space perms
1. Article Addressed to: 8/2 /08 B.M.
PCB 2008-091
Patrick Bryan, R gistered Agent
Surface Manufacturing Company
135 S. 4th Street
Capron, IL 61012
COMPLETE THIS SECTION ON DELIVERY
A. Signature
?
IECAgent
q
Addressee
B.
p d ived by (Printed
Name)
?
Date of Delivery
D.
–lb
Is delivery address
R
different
?
item 1?
q
Yes
If YES, enter delivery address below:
?
VIL.No
3. Service Type
S
Pertlfied Mall
0 Registered
q
Insured Mail
q
Express Mall
q
Retum Receipt for Merchandise
q
C.O.D.
4. Restricted Delivery?
(Extra Fee)
?
q
Yes
2. Article Number
(Transfer from Sen4ce label)
7007
!
3020 00004630 7078
PS Form 3811, February 2004
?
Domestic Return Receipt
102595-02-MA540i
SENDER:
COMPLETE THIS SECTION
COMPLETE THIS
SECTION ON
DELIVERY
■
Complete Items 1, 2, and
3. Also
complete
Item 4 if Restricted Delivery
Is
desired.
■
Print your name and address on the reverse
so that we can return the card to you.
■
Attach this card to the back of the mailpiece,
or on the front
if space permits.
1. Article Addressed to:
8/21/08
B.M.
PCB 2008-091
Patrick Bryan
Surface Manufacturing Compa
W5608 Stateline Road
Walworth, WI
53184
Recall/
?
Pri
D. Is delivery address different
?
em 1?
q
Yes
If YES, enter delivery address below:
?
q
No
ce Type
Certified Mall
q
Express Mail
Registered
?
q
Return
Receipt for Merchandl
q
Insured Mail
?
q
C
.O.D.
4. Restricted Delivery?
(Extra Fee)
?
0 Yes
ature
C. D$te of Delive
AtAgent
2. Article Number
(Transfer from service label)
?
7007 3020 0000 4630 7085
;
PS Form 3811,
February 2004
?
Domestic Return Receipt
102595,02NA!

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