• Complete items 1, 2, and 3. Als~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.

~. ArticleAddressedto:

11/18/04 B .M.

PCB 2005—087

Jonathan Troyer

2703 1720th Place

Clayton, IL 62324

CLERK’S

OFF!CI

STATE

NOV29

0F ILLINOIS

2004

Pollution Control Board

A.

natur

~

00

Agent

Addressee

• 8.~eceivedby

(Printed

Name)

C. D4te of Delivery

0.

If

Is

YES,deliveryenteraddressdeliverydifferentaddress(mmbelow:

item 1? t

0

Y&s

No

t

3. Service Type

ertifled Mail

0 Express Mail

Registered

0 Return Receipt for Merchandise

0 Insured Mail

0 C.0.D.

4.

Restricted Delivery?

(Extra Fee)

0 Yes

2. ArticleNumber

(Transferfromsèr.4celabe!)

7004

0750 0004 3960 1840

‘

PS Form

3811

February 2004

Dome stic Return Receipt

~‘

io~s~o~.it~o

/

SENDER: