OR~G
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    RECE WED
    CLERK’S OFFICE
    DEC
    t32004
    STATE OF ILLINOIS
    PolIut~an
    Control Board
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    item 4 if
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    on the reverse
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    so that we can
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    B.
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    (PnntedN
    C.
    Date of Delivery
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    1.
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    12/2/04
    B.M.
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    If YES,
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    below:
    No
    AC
    2004—13
    Johnna J..~P&thoff,Esq.
    City of Chicago
    Department of Environment
    30
    N. LaSalle Str~iet, Suite 2500 3~
    i~e?ail
    DExp,essMail
    Chicago,
    IL
    606022575
    V3
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    Insured
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    Ci
    C.O.D.
    4.
    Restricted
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    (Extm
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    yes
    2.
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    7~0040750
    00043960
    1864
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