RECEIVED
1. CLERK’S OFFICE
2. STATE OF ILLINOiSPollution Control Board

ORIGINAL

I • Cc

,.Jftèrns 1,2, and S. Also complete

Iteth 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 frnnt if space

permits.

1.MlclsAddressedto:

10/6105 B.M.

PCB 2005—221

Ronald Freeman

200

Mainsail

Drive

Third Lake, IL 60030

RECEIVED

CLERK’S OFFICE

OCT 252005

STATE OF ILLINOiS

Pollution Control Board

I.NK.JJD.JaW*E.

B. Received

by~,int Name)

D~~7Ziver~

delivery address different from ften, I?

O’Yos

If YES,

enter delivery address below:

0 No

Seivlce Type

tertlned

Mall

C Express Mall

RegIstered

0 Return

ReceIpt for Merchandise

Insured Mail

0 C.O.D.

V Restiloted

Delivery? t&tm Fee)

Yes

• 2.

MIcle Number

(TransferfmmseMceIabe~

7005 1160. 0002 2069 3923

PS Form 3811, February 2004

Domestic

Return

Receipt

10259&02-M.1540