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    COMPLETE THIS SECT/ON
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    item
    4 if Restricted Delivery is desired~
    I
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    name
    and address on the reverse
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    1.
    ArticleAddressedto:
    11/4/04
    B.M.
    PCB
    2001—043
    Michael
    Stringini
    1108
    S. Westover Lane
    Schaumburg,
    IL 60193
    RE~~VED
    CLERK’S
    OFRUE
    NOV
    2 92004
    STATE OF
    ILUNOIS
    Pollution Contro$ Board
    A;Signature
    0
    Agent
    ~
    Addressee
    b~
    Received
    by
    (
    dnte,~,yt~)
    ~
    D.
    Is deliveryaddress different
    ftom~tem
    1?
    If YES,
    enter delivery address
    below;
    3.
    SeMceType
    ~Certit1ed
    Meli
    ‘0
    .Regtstered
    0
    Express
    Mail
    0
    Return Recel
    .
    pt
    for Merchandise
    0
    Insured Mail
    0
    C.O.D.
    ,,
    .
    4.
    Restricted
    Delivery?
    (Extra
    Fee)
    0
    yes
    2.
    Article Number
    (Transferfromseivice/abel)
    7004 1160 0005
    4126 0683
    PS ‘Form
    3811,
    February
    2004
    Dor~estic
    RetUrn Receipt
    o
    Yes’
    o
    No
    102595-02-M-15-4O

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