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____

SEP

17

STATE OF

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Pollution Control Board

SENDER:

COMPLETE THISSECTION

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Complete items 1, 2,

and 3.

Also complete

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item

4 if Restricted Delivery is desired.

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Agent

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Print your name and address on the reverse

0 Addres~ee

so that we can

return the card to you.

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by

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Attach this~card

to the back of the mailpiece,

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or on the front

if space permits.

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is deliC’ery address

different

M~m

item 1?

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1..

Article

Addressed to:

9

/

2/04

B

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M.

AC

2005—011

If

YE’S, enter deliveryaddress below:

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No

Gene Stacey

Environmental Reclamation Compat

Route 316 West

_________________________________

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0.

Box

137

~Certifiecf Mail

0

Express Mall

Charleston,

IL

61920

0

Registered

DRetum Receipt for Merchandise

0

Insured Mail

0

C.O~D.

4.

Restricted Delivery?

(Exlia

Fee)

0-Yes

2.

Article

Number

(rransferfrom service label)

7004

1160

0005

4126

2632

.

PS Form

3811.,

February 2004

Domestic Return Receip~

1O2595-O2-M-1~4o

COMPLETE

THIS SEQTION

ON

DELIVE~

SENDER

cOMPLE~

Ti-US

SECTION

________

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Complete itemS 1, 2,

and. 3. Also complete

item

4 if Restricted DeliVe1~/is desired.

•

Print your name and address on the reverse

so that we can return the card to you.

U

Attach this card to the back of the mailPiece,

or on thefront if space permits.-

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AC 2005_Oil

Registered Agent

CT Corporation System

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s

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208

S.

LaSalle

Street,

Suite

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Merchaildtse

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