~iU
    RECE~V~D
    CLERK’S OFFICE
    NOV
    22
    2004
    STATE OF IWNOIS
    Pollution ContrOl Board
    SENDER:
    COMPLETE THIS SECTION
    COMPLETE THISSECTION ON DELIVERY
    •
    Complete items 1, 2,
    and 3.
    Also complete
    item
    4 if Restricted Delivery
    !s desired.
    •
    Print
    your name and address on the reverse
    so that we can return the card tb you.
    .1
    Attach this cartl to the back of the mailpiece,
    or on the
    front
    if space permits.
    ,,i,~ArticleAddressedtó:
    11/4/04
    B.M.
    AC
    2004—027
    ~Douglas
    S.
    Carrico
    19291 Carrico Road
    Kane,
    IL 62054
    A.
    Signature
    x
    B.
    Received by~(
    Printed Nthme)
    C.
    Date of Delivery
    /‘~---~
    D.
    Is delivery
    address different
    from
    item
    1?
    0
    Yes
    If YES, enter
    delivery address below:
    0
    No
    3.
    Srvice Type
    ~OertifiedMail
    0
    Express Mail
    o
    Registered
    0
    Return
    Receipt for Merchandise
    o
    Insured Mail,
    ,
    .0
    C.O.D.
    4
    Restncted Delivery?
    (E~ct~a
    Fee)
    0
    Yes
    2
    Article Number
    (Transfer from
    service
    label)
    7004
    .1160
    0005
    4126
    0584
    I
    ‘PS’
    Form
    3811,
    February 2004.
    Domestic Return
    Receipt
    1O2595~o2-M-l~4o
    o
    Agent
    DAddresseé

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