RECEIVED
    CLERK’S OFFiCE
    ORIGINAL
    AUG
    2
    32005
    STATE OF ILLINOIS
    Pollution
    Control Board
    SENDER:
    COMPLETE THIS SECTION
    COIkV
    ETE THIS SECTION ON
    DELIVERY
    •
    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,
    MicleAddrossed to:
    8/18/05
    B.M.
    PCB
    2006—024
    Tom Scheider
    4778
    W. Empire
    Road
    Freeport,
    IL 61032
    /
    2.
    Article
    Number
    (rransfer from
    service label)
    7004
    2890
    0
    A.
    Signature
    0
    f)
    fi’
    D~Agent
    x
    nr~.~
    ,C~KQJ~fl~’U
    LI
    dresses
    B.
    Rece~ed
    by
    (Printed Name)
    C.
    Date
    of
    Delivery
    Topc’~sahejder~
    ,~lsdelivery address different from
    item
    1?
    0
    Yes
    If
    YES, enter delivery address below:
    0
    No
    3.
    Service type
    ‘$..Certified Mail
    0
    Express Mail
    0
    Registered
    0
    Return
    Receipt for Merchandise
    0
    Insured Mail
    0
    coo.
    4.
    Restricted
    Delivery?
    (Extra
    Fee)
    J
    Yes
    004
    2307
    1636
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    102595-02-M-1540

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