CL~EE~cs

°~FICE

ORIGINAL

JAN

~92OU5

STATE OF

Pollutio~.,Control Board

SENDER

COMPLETE

THIS SECTION

a

Complete items

1, 2, and

3. Also complete

A. Signature

~

0 .Agent

item 4

if Restricted

Delivery

is desired.

X’\

4f~~2

-~~_-C1~2dD

Addressee

~

Print your name and

address on the reverse

_____________________________________________

so that we can return the card to you.

B.

1~ceived

by

(Printed Name)

C

Date a

Delivery

a

Attach this

card to the

backof the mailpiece,

or on the front if space permits.

4INJ~)

~

~TP~CCQ

S~

Is delivery address different from

item 1?

0

Yes

1.

Article Addressed to:

1

/

6

/

05

B

N.

If YES, enter delivery address below:

0

No

AC 2005—035

V

Mr.

Lomac Payton

Knox County Landfill Committee

Knox County Courthouse

3. Service Type

Galesburg,

IL

61401

~Certified•Mail

0

Express

Mail

Registered

0

Return

Receipt for Merchandise

0

Insured Mail

0

C.O.D.

4.

Restricted

Delivery?

(Extra Fee)

0

Yes

2.

ArticleNumber

(rransfer

from

serv/ce

label)

7004

0750

0004

3960

2298

PS

Form

3811,

February 2004

Domestic Return Receipt

102595-02-M1540