R~CE~V~D

CLERK’S OFFICE

SENDER:

COMPLETE THIS

SECTION

a

Complete items 1, 2, and 3. Also complete

item 4 if Restricted Delivery is desired.

• Print ydur name and address on the reverse

so that we can return the card to you.

a

Attach this carx~to the back of the mailpiece,

or on the front if space permits.

1. ArticleAddressedto:

4/7/05

B.N.

PCB 2005—171

Vincent Berghower

9610 N. l300th Street

Newton, IL 62448

PS Form 3811, February 2004

APR 18 2005

STATE OF ILL~4OIS

Pollution COntrOl Board

A. Signature

x

~j1~f

0

Agent

0 Addressee

B. Received by

(Printed N~e)

C. Date of Delivery

D. Is delivery address different fro Item 1? 0 Yes

If YES, enter delivery address below:

0 No

3. Service Type

~~ertified Mail

o Registered

0

Express Mail

0 Return Receipt for Merchandise

o Insured Mail

00.0.0.

2. Article Number

(rransferfrom service

label)

7004 2890 0004 2296 4625

4. Restricted Delivery?

(Extrs

Fee)

0 Yes

Domestic Return Receipt