REC
CLE
EoVEO
APR 0 '12007
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 permits
.
COMPLETE THIS SECTION ON DELIVERY
B. RS~ yeived by (Printed
Name)Name)
A Si
Is delivery address differen m em 1? 0 Ye
If YES, enter delivery address below
:
0 No
4 . Restricted Delivery? (Extra Fee)
C . Date of Deliver
3-
.i
7-c)
0 Yes
1 Article Addressed
0 :
3/15/07 B .M
.
1Ci3 2005-216
and PCB 2005-217
Ryan E
. Mohr
Hodge Dwyer Zeman
3150 Roland Avenue
Post Office Box 5776
Springfield, IL 62705-5776
D
ure
-
Z~
(Transfer from service taboo
7001 1140 0002 7469 0343
PS Form 3811, February 2004
Domestic Return Receipt
11 Agent
0 Address
3 . Service Type
rtrged Mail
0 Express Mail
Registered
0 Return Receipt for Merchandis
0 Insured Mall
0 C .O.D.
102595 .02.M .154
2 . Arfi,- Number
(rrarn4erfrom service label) 7001 1140 0002 7469 0350
PS Form 3811,
February 2004
Domestic Return Receipt
102595-02-10-15
SENDER :
COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
∎ Complete items 1, 2, and 3
. Also complete
A. Sign
item 4 if Restricted Delivery is desired
.
0 Agent
∎ Print your name and address on the reverse
X
0 Addresse
so that we can return the card to you .
B. R ived
by (Printed Name)
C Date of Deliver
∎ Attach this
or on the front
cardIf to
space
the back
permitsof .
the mailpiece,
f)r
i2
n
L e
e
D
. Is delivery address different from Item 1?
0 Yes
1 . Article Addressed to :
3/15/07 B
.M.
If YES, enter delivery address below :
0
No
PCB 2005-21D and PBC 2005-217
Thomas G . Safley
Hodge Dwyer Zeman
Post
3150
Office
Roland
Box
Avenue5776
3.
-frJSe .Gertiged
Ice TypeMall
0 Express Mail
Springfield, IL 62705-5776
[fj Registered
0 Return Receipt for Merchandise
0 Insured Mail
0 C .O.D.
4. Restricted Del ery? (Extra Fee)
0 Yes
2 . Article Number
