CLEFUCS

OFFICE

OCT

02008

STATE

OF

ILLINOIS

Pollution

Control

Board

COMPLETE

THIS

SECTION

ON

DELIVERY

•

Complete

items

1,

2,

and

3.

Also

complete

A.

Signature

item

4

if

Restricted

Deiive

y

is

desired.

x

11

D

Agent

•

Print

your

name

and

address

on

the

reverse

/

/

tUTUC..

D

Addressee

so

that

we

can

return

the

card

to

you.

B.

Recei

ed

by

(Printed

Name)

C.

Date

of

•

Delivery

=

pebrI

mailpiece,

1

.

1

j

/)J,

,ti,/j%

9/.

u

/

8

M

D.

Is

delivery

address

different

from

item

19

Yes

1.

Article

Addressed

to:

E

If

YES,

enter

delivery

address

below:

D

No

FrankH.

Record

Quality

Disposal

334

E.

Fort

Street

__________________________________

Fartningtàn,

IL

61531

3.

ServlceTyPe

Certifled

Mail

D.

Express

Mail

Registered

D

Return

Receipt

for

Merchandise

0

Insured

Mail

0

C.O.D.

4.

Restricted

Delivery?

(&t,a

Fee)

0

Yes

(rransferfrômsendceIabel)

7007

02O0000463O

745O

PS

Form

3811,

February

2004

Domestic

Return

Receipt

102595-02-M-1540