RECE~V~D
CLERK’S OFFICE
SEP
2 ~ 2004
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
‘yo~ir
name
~nd
address on
the
reverse
so that we can return the card to you.
a
Attach this
card to the back of the mailpiece,
or on thefront if space permits.
1. ArtlcloAessedto:
9/2/04
B.N.
AC 2OO5~006
Greg Ingle
P.O. Box 407
Wataga, IL 61488
---~..
-~
a,-.
r~7~
afiteceive~
by
(Pnnte7Name)
C
Date
of
Delivery
~req
/i~Je
D
Is d~very
add,s~s
d’rfferentfrom
Item
1?
0
Yes
If
YE~S~
enter delivery address below:
0
No
.3.
S9~rvice
Type
rtif
led Mail
Registersd
0
ln~ured
Mail
o
Express Mall
:0
Return
Receipt for Merchandise
0
C.O.D.
4.
Restricted Delivery?
(Extra
Fee)
DYes
2.
Article Number
(T,ansfer1romsen’ice1abeI~l
7004 1160 0005 4126 2601
102598-02-M-1540
PS Form
3811.,
February .2004•
.:
Domestic Return Reeeip~
A
Si
nature
0
Agent
~Addreatee