CLERK’S OFFICE
    OCT
    2
    92004
    STATE OF ILLh~OiS
    Pollution
    Control
    6o~r,-~
    1.’
    ArticleAddressedto:
    10/21/04
    B.M.
    I PCB 2004—015
    Kurt J.
    Iorberg
    Telleen,
    Braendle, Horberg
    &
    Smith P.C.
    124 West Exchange Street
    P.O. Box 179
    Cambridge,
    IL 61238
    A.
    “
    Signature
    ~
    —~
    /
    ‘—
    C”
    0
    Agent
    DAddressee
    .
    eceived
    by
    (Prin’
    71
    Name)
    ~(-i/i-7~~•
    C.
    Datyt,f De)very
    /o/?-7,/~f
    3.
    S9~vice
    Type
    ertified
    Mail
    Registered
    0
    Insured Mail
    o
    Express
    MaH
    o
    Return Receiptfor Merchandise
    o
    C.O.D.
    4
    Restncted Delivery?
    (Extra
    Fee)
    DYes
    2~Article NJumbér
    (rransferfromse,vice!abel)
    70041160
    0005
    4126
    3974
    Complete items 1,
    2,
    and 3. Also complete
    item
    4 if Restricted Delivery 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 mail~iece,
    or on the front if space permits.
    J
    0.
    Is
    delivery address different
    frem
    item
    il
    0
    Yes
    If YES, enter delivery address below:
    0
    No
    PS Form 38~
    1,
    February
    2O04
    Domestic Return
    Receipt
    1Q2595-O2-~1~4O

    Back to top