SENDER:
    COMPLETE THIS SECTION
    •
    Complete items 1,2, and 3~
    Also compl~te
    item 4if Restricted Delivery is desired.
    •
    Pnnt your name and address ~n thd reverse
    so that we can
    return the card tO you~
    •
    ~ttach this .~ard
    to the back of the rnailpiece~
    or
    On the front if space permits.
    1;
    Article Addressed to:
    11/4/04
    B .M.
    AC
    2005—004
    W.
    Ed
    Kuersten
    G.T.
    &
    L,,
    Inc.
    22341
    Sherman
    Road
    Steger,
    IL
    60475
    •
    2.
    ArtIcle
    Number
    (Transfer
    from
    sari/ce label)
    _______
    $
    ~orm
    3811,
    Fdbruary 2004
    RECEIVED
    CLERK’S OFFICE
    NOV
    .1
    2
    2004
    STATE OF ILLINOIS
    Pollution Control Board
    4.
    Restricted
    Delivé/~’?
    (ExtraFe)
    •
    Complete items
    1, 2, and 3. Also
    complete
    item
    4 if Restricted Delivery is desired.
    •
    Print
    yourname 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:
    11/4/
    04
    B. N.
    AC
    2005—004
    —
    Registered
    Agent,
    G.T.&L,
    Inc.
    Donald
    P.
    Bailey
    10729
    W.
    159th
    Street
    Orland
    Park,
    IL
    60467
    A. Sig~t~
    ~
    7?a~
    o
    Agent
    IJ Addressee
    B.
    43~~
    4~:&
    ~ved by
    (Pn
    17
    A
    Al
    njed
    Name)
    C.
    Date of Delively
    (k./L
    /1—jo
    ~)‘(
    D.
    Is delivetyaddress different tram
    item 1?
    DYes
    If YES, enter delivery address below:
    lJ
    No
    3.
    Se,rviceTYPe
    ~Certified
    Mail
    t
    Registered
    0
    Insured Mail
    o
    Express MaiF
    O
    Return
    Receipt for Merbhandi~e
    o
    C.O.D..
    4.
    Restricted
    Delive~I?
    (Extra
    Fee)
    DYe~
    2
    Article
    Number
    (Transfer
    from seriice label)
    7004
    1160
    0005
    4126
    0614
    O
    Express Mail
    O
    Return.Recel~t
    for ~1erbhandi5e
    D
    C.O.D.
    7004
    11~00005
    4126
    0607
    DYes
    —•
    Domestic
    Return ~ece~p1
    102595-02’M-i
    540
    PS
    ~brm
    3811,
    February
    2004
    Domestic Return .Rece~pt
    102595-02-M-1540

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