SENDER:
    COMPLETE THIS SECTION
    •
    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 mailpiece,
    or on
    the
    front if space permits.
    1.
    Articl~Addressed
    to:
    4/7/05
    B
    M.
    PCB ~2~OO5—170
    Wil14~in
    Dumoulin
    Dumoulin Farms
    RECEIVED
    CLERK’S OFFICE
    APR
    152005
    STATE OF ILLINOIS
    Pollution Control Board
    ~I~livery’addrsss
    different fmm item 1?
    0
    Yes
    If YES, enter
    delivery
    address below:
    0
    No
    d by
    (Printed
    .
    yarne~
    I
    ~
    C,
    ~
    nate of Deli~D’
    ~
    O ~
    /
    16N393 Walker Road
    Hampshire,
    IL 60140
    3.
    Service Type
    ,~ Certified Mail
    o
    Registered
    0
    Express Mail
    0
    RetUrn Receipt lot Memhandise
    o
    insured Mail
    0
    C.O.D.
    4.
    Restflcted
    Delivery?
    (Extra
    Fee)
    0
    Yes
    2.
    Article
    Number
    (rransferfrom service label)
    7004 2890 0004 2296 4618
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-1540

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