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