ORIGINAL

RECEIVED

CLERKS OFFICE

OCT

312005

STATE OF ILLINOIS

Pollution Control Board

~4PLETETHIS SECTION

ms

1, 2,

and 3. Also complete

icted Delivery is desired.

o

and

address

on

the

reverse

mturn the card

to

you.

o the

back of the

mailpiece,

space

permits.

COMPLETE THIS SECTION ON

DELIVERY

A.

Recptved by

(Please

Print Clearly)

rit’rl,.t111

~aAC-

C.

Signature

or

Delivery

C

Agent

C

Addressee

a:

10/20/05

B.M.

4

ter

“

‘1obile

Home

Park

~oute

45—52

L

60922

£iL~’d

reJTe,~

D.

Is

delivery address different from

item

1?

0

Yes

It YES,

enter delivery address

below:

0

No

/

3.

Service Type

ertilied Mail

C

Express Mail

D

Registered

C

Return

Receipt tar Merchandise

C

Insured Mail

C

COD.

~tric

ted

Del ivery?

(Ex tra

Fee)

C

yes

y

from service

label)

0002

2069

4043

dy 1999

Domestic Return

Receipt

1025g5-9q.M-1789