CLERK’S

OFFICE

OCT

2’]

2008

STATE

OF

ILLINOIS

Pollution

Control

Board

SENDER:

COMPLETE

THIS

SECTION

COMPLETE

THIS

SECTION

ON

DELIVERY

Complete

items

1,

2,

and

3.

Also

complete

A.

Signature

item

4

if

Restricted

Delivery

is

desired.

D

Agent

U

Print

your

name

and

address

on

the

reverse

)

>

71

D

Addressee

so

that

we

can

return

the

card

to

YOU.

B.

Received

by

Printed

Name)

C.

Date

of

D

ivery

mailpiece,

/

_‘

,çL

t.-..oO

z

D.

Is

delivery

address

different

from

item

1?

D

Yes

1.

Article

Addressed

to:

10

/

16

/

08

B

M.

/

If

YES,

enter

delivery

address

below

D

No

AC

2009—013

Billy

Hammond,

Sr.

308

B.

Plum

Street

P.O.

Box

263

3.

Service

Type

Benton,

IL

62812

ertified

Mail

D

Express

Mail

ii

Registered

D

Return

Receipt

for

Merchandise

C)

Insured

Mail

C)

C.O.D.

4.

Restricted

Delivery?

(Extra

Fee)

C)

Yes

2.

Article

Number

(Transfèrfrà,rrsèñ,icelabél);

70080500

000

4545

6318::

PS

Form

3811,

February

2004

Domestic

Return

Receipt

102595-02-M-1540