•
    Complete items 1~
    ?~
    and 3. Also complete
    item 4 if RestrictedDelivery is desired;
    •
    Print your name 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:
    8/5/04
    B. N.
    T~
    PCB 2005—011
    Keith Honegger
    3200 Old Troy Road
    Glen Carbon,
    IL 62034
    2.
    ArticleNumber
    (rransferfmmser4celabe9
    7004
    1160
    0005
    A.
    Signature
    ri
    DAgent
    X
    ~
    ~
    (~j—~i1)ç~.
    0
    Addressee
    ,p~eceived
    by
    (PrintedNam~\
    TO.
    Da,of~7erY
    0.
    Is de~very
    address different l~Dm’4m
    1?
    0
    Yes
    If YES, enter delivery
    address below:
    0
    No
    3.~S~rvice
    Type
    ,~..9ertifled
    Mail
    0
    Express Mail
    o
    Registered
    0
    Return
    Receipt for Memhandise
    o
    Insured
    Mail
    0
    0.0.0.
    4.
    Restricted Delivery?
    (Extia
    Fee)
    0
    Yes
    4126 3028
    ~P~or811,February~bO4~
    (U
    boi~n~tldR~tU(r~Fleceipt
    1o259~o?~M(i~1j
    RECEfl/ED
    CLERK’S OFFICE
    AUG
    17
    2004
    STATE OF ILLINOIS
    Poflution Control Board

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