SENDER:
    COMPLETE THIS SECTION
    •
    Complete items
    1, 2, and 3. Also complete
    item 4 if Restricted Delivery is
    desired.
    •
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    so
    that we can
    return the card to you.
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    Attach .this
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    1.
    Article Addressé~i
    to:
    5
    /
    19
    /
    05
    B
    ~
    AC 2005—062
    Tom Fre~e
    RECE~VED
    CLERK’S OFFICE
    MAY
    312005
    STATE OF ILLINOIS
    Pollution
    Control Board
    F.I.M.,
    Inc.
    1627 State Street
    Quincy, IL 62301
    2.
    Article Number
    (rransferfromser.’IceIabel)
    7004
    2890
    0004
    2307
    0936
    A
    x
    Signature
    ~
    (~)
    ~y~”
    El Agpnt
    0
    Addressee
    •
    eceived by
    (
    ed Name)
    iCi(~
    C.
    Date of Daily
    ~
    Dr1~delivety
    addres~fifferent
    frcm item 1?
    0
    Yes
    if YES, enter delivery address below:
    0
    No
    3.
    Service Type
    ~..çertified
    Mall
    o
    Registered
    D
    Express Mail
    0
    Return Receipt for Merchandise
    o
    insured Mail
    0
    C.O.D.
    4.
    RestrIcted Delivery?
    (Extrs
    Fee)
    0
    Yes
    PS
    Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-1540

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