•
    Complete items
    1
    2
    and 3
    Also complete
    item
    4 ifRestncted
    Delivery is
    desired
    •
    Pnnt your name and address on the reverse
    so that we can return the card to you
    •
    Attach this cardto the back of the
    mailpiece,.
    or on the front if space permits
    1.
    Article Addressed to:
    8/5
    /
    04
    B
    •
    M.
    PCB
    2005—011
    UAP
    Richter
    1076
    Corregidor
    Dixon,
    IL
    61021
    2.Art
    k~re
    ~22i4~Addresse~
    Received by
    (P
    nted Name)
    C.
    to of Delive
    D.
    Is delivery address different from
    item 1?
    0
    Yes
    If YES, enter delivery address below:
    0
    No
    3.
    Service Type
    ertified
    Mail
    0
    Express Mail
    Registered
    0
    Return Receiptfor Merchandise
    o
    Insured
    Mail
    0
    C.O.D.
    -
    -
    -
    -
    DYes
    RECEW~D
    CLERK’S OFFICE
    AUG16
    2004
    STATE OF ~LUNO~S
    Pollution Contr0~Board

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