I~~i~AL

a

Complete items

1, 2,

and 3. Also complete

item

4 if Restricted Delivery, is desired.

m

Print your name and 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 the front

if space permits.

1.

ArticleAddressedto:

2/17/05

B.N.

PCB

2005—152

Robert

Furtney

2308 County Road 900E

Champaign,

IL 61822

RECEIVED

CLERK’S OFFICE

FEB 28

2005

STATE OF ILLINOIS

Pollution Control Board

A.

Signature

X

.f•

),i~,

D.IS

delivery &tdress different f&n item

1?

~

Ye’s

If YES, enter delivery address below:

0

No

SENDER

COMPLETE THIS

SECTION

COMPLETE THIS SECTION ON

DELIVERY

.0

Agent

Addressee.

B. ~Received

by

~~kli”~’i

(P,rinfedName)

~

C. Date o~,Deliv~y

.3.

Sprvice Type

~rtified

Mail

o

Registered

0

Express Mail

0

Return

ReceIpt for Merchandise

o

Insured Mail

0

0.0.0.

2.

Article

Number

(Transferfrom service label)

7004

2890

0004

2296

0924

4.

Restricted Delivery?

(Extra Fee)

0

Yes

PS Form

3811,

February 2004

Domestic..Return Receipt

102595-02-M-1540